Bonus Material-04_Khurana_Asthma_2025

Pdf Summary

This comprehensive Pulmonary Board Review on asthma by Dr. Sandhya Khurana covers pathophysiology, diagnosis, phenotyping, updated management guidelines, biologic therapies, and non-type 2 asthma. Asthma is the most prevalent chronic respiratory disease globally affecting 262 million people, with 26 million Americans affected and a high rate of uncontrolled disease. It is a heterogeneous airway inflammatory disorder characterized by variable symptoms and variable expiratory airflow limitation.<br /><br />Diagnosis emphasizes documenting variable airflow obstruction through spirometry, bronchodilator response, diurnal peak expiratory flow variability, and bronchoprovocation testing with methacholine or exercise challenge. Methacholine challenge is sensitive but not specific and influenced by inhaled corticosteroid use.<br /><br />Phenotyping distinguishes Type 2 (T2) high eosinophilic asthma from T2 low or non-T2 asthma, the latter often corticosteroid resistant with neutrophilic or paucigranulocytic inflammation. Biomarkers including IgE, blood eosinophils, and fractional exhaled nitric oxide (FeNO) help classify asthma endotypes.<br /><br />Management highlights recent updates from GINA and NAEPP emphasizing inhaled corticosteroids (ICS) combined with formoterol as maintenance and reliever therapy across mild to moderate asthma, reducing exacerbations with lower steroid exposure. Addition of long-acting muscarinic antagonists (LAMA) is recommended for uncontrolled severe asthma.<br /><br />Six biologic therapies targeting T2 inflammation are reviewed: omalizumab (anti-IgE), mepolizumab/reslizumab (anti-IL5), benralizumab (anti-IL5 receptor), dupilumab (anti-IL4R blocking IL4/IL13), and tezepelumab (anti-TSLP, effective in T2 and non-T2 asthma). These biologics significantly reduce exacerbations and oral corticosteroid dependence in severe asthma with appropriate biomarker selection. Non-T2 asthma treatments include tezepelumab, macrolides, with bronchial thermoplasty no longer routinely recommended.<br /><br />Additional considerations address asthma mimics, comorbidities (nasal polyps, GERD, obesity, vocal cord dysfunction), occupational asthma, and aspirin-exacerbated respiratory disease. The review stresses early and accurate diagnosis, tailored phenotyping, and stepped treatment including cutting-edge biologics to optimize outcomes.<br /><br />Recent clinical trials demonstrate biologics’ efficacy in reducing exacerbations, improving quality of life, and tapering corticosteroids. Emerging agents like depemokimab show promise. Remission concepts and strategy for biologic tapering are also discussed.<br /><br />In summary, asthma management is evolving with biologics transforming severe asthma care, precision phenotyping guiding therapy, and updated GINA guidelines supporting ICS-formoterol across severity levels to improve patient outcomes.

Meta Tag

Concept Asthma

Concept Type 2 Inflammation

Concept Variable airflow obstruction

Concept NonType 2 Inflammation

Concept GINA Guideline

Keywords

asthma

pulmonary board review

spirometry

Type 2 inflammation

non-Type 2 asthma

FeNO

ICS-formoterol

biologic therapies

GINA guidelines

mepolizumab

Asthma

Type 2 Inflammation

Variable airflow obstruction

NonType 2 Inflammation

GINA Guideline