Moderator of 3 Sessions
Non-type 2 asthma represents about 20-30% of all severe asthmatics. At the present time, there is no specific biomaker that may identify this specific endotype, apart from the absence of type 2 eosinophilic inflammation.; probably, in the next future we would have different biomarkers able to distinguish different subgroups in this large cohort of asthmatic subjects. This endotype may be frequently associated with some comorbidities, like obesity, gastroesophageal reflux of smoking habit). Noneosinophilic severe asthmatics not adequately controlled with the best of the standard therapy may require the addition of other drugs (tiotropium as first additional option, oral theophylline, or long-term macrolide therapy or PDE4 inhibitors). These patients usually respond poorly to oral corticosteroids, but, in any case, this treatment is often used by the majority of the patients, for the lack of significant and effective alternatives.
Learning Objectives:•Know how to diagnose this subgroup of severe asthmatics.
• Know the pathogenetic mechanisms of this specific endotype.
• Select the appropriate treatment and management of these “difficult-to-treat” patients.
This interactive session will provide the audience with an update on immunopathologic mechanisms of severe asthma and the role of viral infections in asthma exacerbations. The audience will hear about practical approaches to phenotyping and endotyping in severe asthma. This session will focus on current knowledge regarding the add-on biological therapies of severe asthma, including the humanized monoclonal anti-IgE antibody omalizumab, anti-IL-5 monoclonal antibodies mepolizumab and reslizumab, the IL-5 receptor blocker benralizumab, and the dual IL-4/IL-13 receptor antagonist dupilumab. Future biological approaches will be also considered, as well as nonbiological strategies, such as pharmacologic antagonism of CRTH2 receptor of prostaglandin D2.
Learning Objectives:• Recognize the recent advances in the understanding of pathobiology of asthma.
• Understand the role of viral infections in asthma exacerbations.
• Review available therapeutic options, current and novel, in severe asthma.