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Blood eosinophils: In quest of a Holy Grail for personalized asthma treatment with biologicals

Publication at First Faculty of Medicine |
2020

Abstract

Treatment strategies for asthma are changing dramatically with many novel molecules entering the market, especially within the group of biologicals. Intensive investigations continue to reveal new pathogenetic aspects of the chronic airway inflammation allowing identifying a variety of asthma subendotypes and potential therapeutic targets.

Better understanding of the underlying mechanisms as well as contributing factors and triggers allows personalized therapeutic approach respecting individual characteristics of distinct patients. This is a prerequisite both for long-term effective outcome as well as for safety and good tolerability of the therapy.

In daily practice, physicians decide on currently available (type 2) targeted treatment options based on (non) invasive clinical and laboratory parameters, indicative of distinct asthma phenotypes or endotypes (Figure 1). Therapeutic response can thus be predicted by various biomarkers, either alone or in combination.1 Presently, the most frequently studied and commonly used biomarkers include eosinophils (from peripheral blood or sometimes from induced sputum), serum total IgE and fractional exhaled nitric oxide (FENO) levels.