New options for severe asthma

Abstract

 The review provides current data on new options for the treatment of severe bronchial asthma. The prevalence of severe asthma ranges from 3% to 10%, but it is for the treatment of this group of patients that more than 80% of the funds allocated for the treatment of the disease as a whole are spent. Patients with severe bronchial asthma make up a special category, since traditional therapy, effective in most patients with bronchial asthma, does not allow controlling the disease. Heterogeneity and multivariate disease dictate the need to develop a personalized approach, which is impossible without significant financial and personnel investments. Understanding the pathogenetic pathways underlying the development of inflammation in asthma was the impetus for  the development of  targeted therapies. Five genetically engineered immunobiological drugs have been developed and approved for  patients with severe allergic and/or eosinophilic bronchial asthma. The choice of  the right medication should depend on the correct diagnosis of severe asthma, understanding the patient’s endotype, and accounting for patient-specific factors. It is worth noting that all approved biologics and most biologics currently in development focus on T2-immune response. To be sure, there is a huge pool of patients who register a different type of inflammation. And therefore, despite the rapid development of knowledge in the field of targeted therapy of bronchial asthma, further decoding and deepening of knowledge about the pathophysiological mechanisms, in particular non-T2 inflammation, as well as an analysis of the experience of using existing drugs to clearly understand the indications, as well as to assess the effectiveness and safety of existing treatments.