Mario Cazzola, Clive p Page, Maria Gabriella Matera, Paola Rogliani, Nicola A. Hanania

European Respiratory Journal 2023; DOI: 10.1183/13993003.00700-2023

Abstract

Several current guidelines/strategies outline a treatment approach to asthma, which primarily consider the goals of improving lung function and quality of life and reducing symptoms and exacerbations. They suggest a strategy of stepping-up or down treatment, depending on the patient's overall current asthma symptom control and future risk of exacerbation. While this stepwise approach is undeniably practical for daily practice, it does not always address the underlying mechanisms of this heterogeneous disease. In the last decade, there has been an attempt to improve the treatment of severe asthma such as the addition of long-acting antimuscarinic agent to the traditional ICS/LABA treatment, and the introduction of therapies targeting key cytokines. However, despite such strategies several unmet needs in this population remain, motivating research to identify novel targets and develop improved therapeutic and/ or preventative asthma treatments. Pending the availability of such therapies, it is essential to re-evaluate the current conventional 'one-size-fits-all' approach to a more precise asthma management. Although challenging, identifying 'treatable traits” that contribute to respiratory symptoms in individual patients with asthma may allow a more pragmatic approach to establish more personalized therapeutic goals.