Novel therapeutic approaches targeting endotypes of severe airway disease

ABSTRACT

Introduction: Severe asthma and chronic rhinosinusitis (CRS), with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP), are heterogeneous diseases characterized by different mechanistic pathways (endotypes) and variable clinical presentations (phenotypes).

Areas covered: This review provides the clinician with an overview of the prevalence and clinical impact of severe chronic upper and lower airways disease and suggests a novel therapeutic approach with biological agents with possible biomarkers. To select relevant literature for inclusion in this review, we conducted a literature search using the PubMed database, using terms ‘severe airways disease’ AND ‘endotype’ AND ‘treatment.’ The literature review was performed for publication years 2010–2020, restricting the articles to humans and English language publications.

Expert opinion: The coronavirus disease (COVID-19) pandemic has brought forth many challenges for patients with severe airway disease and healthcare practitioners involved in care. These patients could have an increased risk of developing severe SARS-CoV-2 disease, although treatment with biologics is not associated with a worse prognosis. Eosinopenia on hospital admission plays a key role as a diagnostic and prognostic biomarker.

KEYWORDS:

• Severe airway disease
• severe asthma
• chronic rhinosinusitis
• nasal polyposis
• biomarker
• endotype
• phenotype
• biologics therapy

Article highlights

• Severe asthma and chronic rhinosinusitis (CRS) affect people of any age and are associated with a significant socioeconomic burden.

• Understanding the underlying pathophysiological mechanisms (endotypes) combined with the use of several biomarkers may aid in the precise phenotyping and endotyping of severe asthma and CRS patients and the identification of the best candidates for the novel targeted therapies.

• Biological therapies targeting type 2 inflammation represent the most innovative therapies for severe asthma and uncontrolled chronic rhinosinusitis with nasal polyps.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer of this manuscript has disclosed that they recruited patients to trials of biologics in non CRS areas.

A different reviewer of this manuscript disclosed that they have received travel Grants from ASTRA-ZENECA, NOVARTIS, GSK, BOEHRINGER INGELHEIM, ELPEN, BAYER, MENARINI, CHIESI and PHARMATEN.

They have also received honorarium lecture fees from NOVARTIS, ASTRA ZENECA, ELPEN, CHIESI, BOEHRINGER INGELHEIM, ΜΕΝΑRINI and GSK. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.