4.7 Article

Advances in asthma: New understandings of asthma's natural history, risk factors, underlying mechanisms, and clinical management

Journal

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 148, Issue 6, Pages 1430-1441

Publisher

MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2021.10.001

Keywords

Asthma; biomarkers; genetics; microbiome; viral infec-tions; cytokines; tryptase; T cells; innate lymphoid cells; macro-phages; epithelium; scoring systems; airway physiology; biologics

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In the past two years, there has been significant growth in high-quality asthma research, leading to new understandings of asthma incidence, natural history, risk factors, and potential therapeutic interventions. The progress in understanding mechanisms of asthma development and exacerbations, as well as advancements in diagnostic tools and precision approaches, have been immense and impactful. Though further knowledge on novel therapeutics and different asthma phenotypes is needed, these recent advancements offer promising avenues for future asthma management.
The last 2 years yielded a proliferation of high-quality asthma research. These include new understandings of the incidence and natural history of asthma, findings on the effects of exposure to air pollution, allergens, and intake of acetaminophen, soy isoflavones, and polyunsaturated fatty acids, and exposure to microbial products. The past 2 years have benefited from great strides in determining potential mechanisms of asthma development and asthma exacerbations. These novel understandings led to identification and development of exciting new avenues for potential therapeutic intervention. Finally, there has been significant progress made in the development of tools to facilitate the diagnosis of asthma and measurement of airway physiology and in precision diagnostic approaches. Asthma guidelines were updated and new insights into the pharmacologic management of patients, including biologics, were reported. We review the most notable advances in the natural history of asthma, risk factors for the development of asthma, underlying mechanisms, diagnostic approaches, and treatments. Although greater knowledge of the mechanisms underlying responses and nonresponses to novel therapeutics and across asthma phenotypes would be beneficial, the progress over just the past 2 years has been immense and impactful.

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