Untangling asthma phenotypes and endotypes

Authors

  • I. Agache,

    Corresponding author
    • Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University, Brasov, Romania
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  • C. Akdis,

    1. Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
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  • M. Jutel,

    Corresponding author
    1. Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
    • Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University, Brasov, Romania
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  • J. C. Virchow

    1. Department of Pulmonology, Intensive Care Medicine, Zentrum f. Innere Medizin, Klinik I, University Clinic Rostock, Rostock, Germany
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  • Edited by: Hans-Uwe Simon

Correspondence

Ioana Agache, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Nicolae Balcescu 56, Brasov, Romania.

Tel.: +40 727 849 321

Fax: +40 268 471 814

E-mail: ibrumaru@unitbv.ro

and

Marek Jutel, Department of Clinical Immunology, Wroclaw Medical University, Chalubinskiego Str. No 5, PL- 50368, Wroclaw, Poland.

Tel.: 71 784 17 40

Fax: 71 784 04 17

E-mail: mjutel@ak.am.wroc.pl

Abstract

Asthma phenotypes have been developed to address the complexities of the disease. However, owing to a lack of longitudinal studies, little is known about the onset as well as the stability of phenotypes. Distinguishing phenotypes with regard to the severity or duration of the disease is essential. A phenotype covers the clinically relevant properties of the disease, but does not show the direct relationship to disease etiology and pathophysiology. Different pathogenetic mechanisms might cause similar asthma symptoms and might be operant in a certain phenotype. These putative mechanisms are addressed by the term ‘endotype’. Classification of asthma based on endotypes provides advantages for epidemiological, genetic, and drug-related studies. A successful definition of endotypes should link key pathogenic mechanisms with the asthma phenotype. Thus, the identification of corresponding molecular biomarkers for individual pathogenic mechanism underlying phenotypes or subgroups within a phenotype is important. Whether newly defined asthma endotypes predict the individual course of asthma has to be validated in longitudinal studies. The accurate endotyping reflects natural history of asthma and should help to predict treatment response. Thus, understanding asthma endotypes might be useful in clinical practice.

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