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Abstract
Asthma is a complex and heterogeneous disease, which is comprised of seperate phenotypes sharing common characteristics, such as airway inflammation, bronchial hyperresponsiveness and variable airflow limitation. Traditionally, asthma phenotypes have been described by combinations of clinical characteristics, according to the expert's recommendation, but they are now focusing on the pathobiologic mechanisms often using exploratory statistical methods. Several phenotypes and endotypes have been suggested by biased or unbiased phenotyping approaches. However, more detailed studies are still needed. In the future, more integrated large-scaled consortium of cohorts, including clinical information, genetics, molecular biology, and experiments will promote to understand the pathobiologic mechanisms of asthma phenotypes for the personalized therapy.
Figures and Tables
Fig. 1
Schematic representation of the umbrella term 'asthma'. The key clinical features of severity (lung function, symptoms and exacerbations), inflammatory characteristics (particularly TH2 immunity) and their division into associated phenotypes are shown. However, these phenotypes have not yet been fully characterized (reprinted from Wenzel SE. Nat Med 2012;18:716- 25, with permission of Nature Publishing Group).2)
Fig. 2
Estimated prevalence at each time point from birth to age 8 years for each wheezing phenotype (A) in Avon Longitudinal Study of Parents And Children (ALSPAC) free 6-class model (n=5,760), (B) in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) optimal 5-class model (n=2,810) (reprinted from Savenije OE, et al. J Allergy Clin Immunol 2011;127: 1505-12.e14., with permission of Elsevier).30)
Fig. 3
Overview of Mechanisms of the Development of ALLergy (MeDALL) (Bousquet J, et al. Allergy 2011;66:596-604, with permission of John Wiley & Sons).38)
Table 1
Asthma Phenotypes in Relation to Characteristics
IgE, immunoglobulin E; SBM, subepithelial basement membrane; IL, interleukin; FEV1, forced expiratory volume in 1 second.
Reprinted from Wenzel SE. Nat Med 2012;18:716-25, with permission of Nature Publishing Group.2)
Table 2
Methods of Classification of Asthma Phenotypes in Children
BAL, bronchoalveolar lavage.
Reprinted from Henderson J, et al. Arch Dis Child 2009; 94:333-6, with permission of BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.15)
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