Introduction
Asthma is a chronic heterogeneous disease of the lower airways characterized by chronic inflammation and airway hyperreactivity leading to cough, wheeze, difficulty in breathing and chest tightness. The pathophysiology of asthma is complex. In the past three decades a better understanding of distinct asthma visible properties (phenotypes) and mechanisms (endotypes) shaped better diagnostic and therapeutic tools in support of stratified/personalised interventions based on recognition of differences in responsiveness to various therapeutic interventions (theratypes).1,2 In addition, environmental factors, genetic polymorphisms and epigenetic factors contribute to the development of asthma, heterogeneity in phenotyping and steroid responsiveness.3-6 Environmental interventions and exposure control can improve asthma control and exacerbations.7
The incidence and prevalence of asthma are increasing, though regular use of inhaled corticosteroids (ICS) reduces mortality.8,9 New therapies and therapeutic targets are required for better control of symptoms and exacerbations in severe asthma patients and for avoiding adverse reactions caused by the administration of oral corticosteroids (OCS).
This review highlights the recent studies on immunopathological pathways, molecular mechanisms, various environmental factors and microbial dysbiosis in asthma. Clinical trials, multi-centered international studies and real-world data are reviewed for novel approaches in asthma diagnosis, candidate biomarkers and management of asthma in adults and children.