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Asthma phenotyping involves identifying distinct asthma subtypes based on clinical, inflammatory, and molecular characteristics to guide personalized treatment approaches. Biologic selection utilizes specific biomarkers and phenotypic features to match patients with targeted monoclonal antibody therapies for optimal therapeutic outcomes.
Different asthma phenotypes exhibit distinct inflammatory pathways, with Type 2 (T2)-high asthma driven by IL-4, IL-5, and IL-13 cytokines leading to eosinophilia and IgE elevation, while T2-low asthma involves neutrophilic inflammation and Th1/Th17 pathways. Specific phenotypes include allergic asthma with IgE-mediated responses, eosinophilic asthma with IL-5 predominance, and aspirin-exacerbated respiratory disease involving leukotriene pathway dysregulation.
Phenotyping guides biologic selection by matching inflammatory patterns to targeted therapies: anti-IgE (omalizumab) for allergic asthma with elevated total IgE, anti-IL5/IL5R agents (mepolizumab, benralizumab) for eosinophilic asthma, and anti-IL4/IL13 pathway inhibitors (dupilumab) for T2-high asthma with elevated fractional exhaled nitric oxide or eosinophils. Biomarkers including blood eosinophil count, total IgE, specific IgE levels, and FeNO measurements help predict treatment response and optimize therapeutic selection.