Asthma: Current Concepts in Pathogenesis, Precision Medicine and Emerging Therapeutic Strategies

Authors

  • N Sanjeyan Department of Pharmacy Practice, JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India. https://orcid.org/0000-0003-4159-3116
  • P Karthickkishore JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India. https://orcid.org/0009-0000-8101-8867
  • M Avin JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India. https://orcid.org/0009-0005-7401-5015
  • K S Hari Haran JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India. https://orcid.org/0009-0002-4665-5515

Abstract

Objectives: To review current concepts in asthma pathogenesis, phenotypes, endotypes, precision medicine, biologic therapies, and emerging therapeutic strategies, with emphasis on recent advances in personalized asthma management.

Data Sources: Peer-reviewed articles were identified through searches of PubMed, Scopus, Web of Science, and Google Scholar, together with relevant international asthma guidelines.

Study Selection: Relevant original research articles, systematic reviews, meta-analyses, and international clinical guidelines were selected based on their relevance to asthma pathogenesis, biomarkers, precision medicine, biologic therapies, and emerging therapeutic strategies.

Summary of Contents: Asthma is a heterogeneous chronic inflammatory airway disease resulting from complex interactions among genetic susceptibility, environmental exposures, epithelial dysfunction, and dysregulated immune responses. Advances in the understanding of asthma phenotypes and endotypes have facilitated biomarker-guided treatment and precision medicine. Targeted biologic therapies directed against immunoglobulin E, interleukin (IL)-5, IL-4/IL-13, and thymic stromal lymphopoietin have significantly improved outcomes in severe type 2 asthma. Emerging approaches, including treatable traits, omics technologies, pharmacogenomics, artificial intelligence, smart inhalers, nanomedicine, gene- and RNA-based therapies, and digital health, are further transforming individualized asthma care.

Conclusion: Precision medicine has substantially improved asthma management through biomarker-guided therapeutic selection and targeted biologic therapy. Future research should focus on reliable biomarkers, disease-modifying therapies, non-type 2 asthma, equitable access to advanced treatments, and strategies to achieve long-term remission and disease prevention.

Keywords: Asthma; Pathogenesis; Precision medicine; Biologic therapy; Phenotypes; Endotypes; Biomarkers; Emerging therapies.

Keywords:

Asthma, Biomarkers, Pathogenesis, Precision medicine

DOI

https://doi.org/10.22270/jddt.v16i9.7934

Author Biographies

N Sanjeyan, Department of Pharmacy Practice, JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

Department of Pharmacy Practice, JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

P Karthickkishore, JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

M Avin , JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

K S Hari Haran , JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

JKKMMRF's Annai JKK Sampoorani Ammal College of Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, Komarapalayam, Namakkal District, Tamil Nadu, India.

References

1. Porsbjerg C, Melén E, Lehtimäki L, Shaw DE. Asthma. Lancet. 2023;401(10379):858-873. https://doi.org/10.1016/S0140-6736(22)02125-0 PMid:36682372

2. Jayasooriya SM, Devereux G, Soriano JB, Singh N, Masekela R, Mortimer K, et al. Asthma: epidemiology, risk factors, and opportunities for prevention and treatment. Lancet Respir Med. 2025;13(8):725-738. https://doi.org/10.1016/S2213-2600(24)00383-7 PMid:40684789

3. Wang Z, Li Y, Gao Y, et al. Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Respir Res. 2023;24:169. https://doi.org/10.1186/s12931-023-02475-6 PMid:37353829 PMCid:PMC10288698

4. Holgate ST, Wenzel S, Postma DS, Weiss ST, Renz H, Sly PD. Asthma. Nat Rev Dis Primers. 2015;1:15025. https://doi.org/10.1038/nrdp.2015.25 PMid:27189668 PMCid:PMC7096989

5. Kato A, Kita H. The immunology of asthma and chronic rhinosinusitis. Nat Rev Immunol. 2025;25(8):569-587. https://doi.org/10.1038/s41577-025-01159-0 PMid:40240657 PMCid:PMC12560183

6. Hammad H, Lambrecht BN. Dendritic cells and epithelial cells: linking innate and adaptive immunity in asthma. Nat Rev Immunol. 2008;8(3):193-204. https://doi.org/10.1038/nri2275 PMid:18301423

7. Camoretti-Mercado B, Lockey RF. Airway smooth muscle pathophysiology in asthma. J Allergy Clin Immunol. 2021;147(6):1983-1995. https://doi.org/10.1016/j.jaci.2021.03.035 PMid:34092351

8. Anderson GP. Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease. Lancet. 2008;372(9643):1107-1119. https://doi.org/10.1016/S0140-6736(08)61452-X PMid:18805339 PMCid:PMC6549890

9. Joseph C, Tatler AL. Pathobiology of airway remodeling in asthma: the emerging role of integrins. J Asthma Allergy. 2022;15:595-610. https://doi.org/10.2147/JAA.S267222 PMid:35592385 PMCid:PMC9112045

10. Barnes PJ. Immunology of asthma and chronic obstructive pulmonary disease. Nat Rev Immunol. 2008;8(3):183-192. https://doi.org/10.1038/nri2254 PMid:18274560 PMCid:PMC13286889

11. Berend N, Salome CM, King GG. Mechanisms of airway hyperresponsiveness in asthma. Respirology. 2008;13(5):624-631. https://doi.org/10.1111/j.1440-1843.2008.01330.x PMid:18713086

12. Moffatt MF, Gut IG, Demenais F, et al. A large-scale, consortium-based genomewide association study of asthma. N Engl J Med. 2010;363(13):1211-1221. https://doi.org/10.1056/NEJMoa0906312 PMid:20860503

13. Ober C, Yao TC. The genetics of asthma and allergic disease: a 21st century perspective. Immunity. 2011;35(5):646-656.

14. Kabesch M, Tost J. Recent findings in the genetics and epigenetics of asthma and allergy. Semin Immunopathol. 2020;42(1):43-60. https://doi.org/10.1007/s00281-019-00777-w PMid:32060620 PMCid:PMC7066293

15. Yang IV, Schwartz DA. Epigenetic mechanisms and the development of asthma. J Allergy Clin Immunol. 2012;130(6):1243-1255. https://doi.org/10.1016/j.jaci.2012.07.052 PMid:23026498 PMCid:PMC3518374

16. Platts-Mills TAE. The role of allergens in allergic airway disease. J Allergy Clin Immunol. 2015;136(4):845-852.

17. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383(9928):1581-1592. https://doi.org/10.1016/S0140-6736(14)60617-6 PMid:24792855 PMCid:PMC4465283

18. Huang K, Yang X, Liang F, et al. Long-term exposure to air pollution and asthma: recent advances and future directions. Chest. 2024;165(3):623-636.

19. Polosa R, Thomson NC. Smoking and asthma: dangerous liaisons. Eur Respir J. 2013;41(3):716-726. https://doi.org/10.1183/09031936.00073312 PMid:22903959

20. Tarlo SM, Lemiere C. Occupational asthma. N Engl J Med. 2014;370(7):640-649. https://doi.org/10.1056/NEJMra1301758 PMid:24521110

21. Baur X. A compendium of causative agents of occupational asthma. J Occup Med Toxicol. 2013;8:15. https://doi.org/10.1186/1745-6673-8-15 PMid:23706060 PMCid:PMC3665602

22. Agache I, Akdis CA, Akdis M, et al. EAACI Biologicals Guidelines-recommendations for severe asthma. Allergy. 2021;76(1):14-44. https://doi.org/10.1111/all.14425 PMid:32484954

23. Fahy JV. Type 2 inflammation in asthma-present in most, absent in many. Nat Rev Immunol. 2015;15(1):57-65. https://doi.org/10.1038/nri3786 PMid:25534623

24. Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med. 2012;18(5):716-725. https://doi.org/10.1038/nm.2678 PMid:22561835

25. McGregor MC, Krings JG, Nair P, Castro M. Role of biologics in asthma. Am J Respir Crit Care Med. 2019;199(4):433-445. https://doi.org/10.1164/rccm.201810-1944CI PMid:30525902 PMCid:PMC6835092

26. Brusselle GG, Koppelman GH. Biologic therapies for severe asthma. N Engl J Med. 2022;386(2):157-171. https://doi.org/10.1056/NEJMra2032506 PMid:35020986

27. Ray A, Kolls JK. Neutrophilic inflammation in asthma and association with disease severity. Trends Immunol. 2017;38(12):942-954. https://doi.org/10.1016/j.it.2017.07.003 PMid:28784414 PMCid:PMC5711587

28. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-1179. https://doi.org/10.1016/j.jaci.2018.02.004 PMid:29627041 PMCid:PMC5973542

29. Lugogo N, Kraft M, Dixon AE. Does obesity produce a distinct asthma phenotype? J Appl Physiol (1985). 2010;108(3):729-734. https://doi.org/10.1152/japplphysiol.00845.2009 PMid:19875708 PMCid:PMC2838637

30. Parsons JP, Hallstrand TS, Mastronarde JG, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013;187(9):1016-1027. https://doi.org/10.1164/rccm.201303-0437ST PMid:23634861 PMCid:PMC10038260

31. Weiler JM, Bonini S, Coifman R, et al. American Academy of Allergy, Asthma & Immunology work group report: exercise-induced asthma. J Allergy Clin Immunol. 2007;119(6):1349-1358. https://doi.org/10.1016/j.jaci.2007.02.041 PMid:17433829

32. Global Initiative for Asthma. Global strategy for asthma management and prevention: 2025 update. Fontana (WI): Global Initiative for Asthma; 2025.

33. Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations. Am J Respir Crit Care Med. 2009;180(1):59-99. https://doi.org/10.1164/rccm.200801-060ST PMid:19535666

34. Hekking PWP, Wener RR, Amelink M, et al. The prevalence of severe refractory asthma. J Allergy Clin Immunol. 2015;135(4):896-902. https://doi.org/10.1016/j.jaci.2014.08.042 PMid:25441637

35. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948-968. https://doi.org/10.1183/09031936.05.00035205 PMid:16264058

36. Khatri SB, Iaccarino JM, Barochia A, et al. Use of fractional exhaled nitric oxide to guide the treatment of asthma: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2021;204(10)-e109. https://doi.org/10.1164/rccm.202109-2093ST PMid:34779751 PMCid:PMC8759314

37. Couillard S, Jackson DJ, Johnston SL, Pavord ID. Biomarkers of type 2 inflammation in asthma: a systematic review and meta-analysis. Eur Respir J. 2022;60(1):2201147.

38. Agache I, Akdis CA, Akdis M, et al. EAACI biologicals guidelines: biomarkers in asthma. Allergy. 2023;78(11):2940-2963.

39. Diamant Z, Vijverberg SJH, Alving K, et al. Toward clinically applicable biomarkers for asthma: an EAACI position paper. Allergy. 2019;74(10):1835-1851. https://doi.org/10.1111/all.13806 PMid:30953574

40. Papi A, Brightling C, Pedersen SE, Reddel HK. Asthma. Lancet. 2018;391(10122):783-800. https://doi.org/10.1016/S0140-6736(17)33311-1 PMid:29273246

41. Beasley R, Holliday M, Reddel HK, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380(21):2020-2030. https://doi.org/10.1056/NEJMoa1901963 PMid:31112386 PMCid:PMC7332932

42. Barnes PJ. Inhaled corticosteroids. Pharmacol Ther. 2022;237:108166.

43. Cazzola M, Rogliani P, Matera MG. β2-Adrenoceptor agonists: current and future direction. Br J Pharmacol. 2022;179(19):4452-4470.

44. Virchow JC, Kuna P, Paggiaro P, et al. Tiotropium add-on therapy in asthma: a systematic review and meta-analysis. Respir Med. 2019;152:34-42.

45. Israel E, Reddel HK. Severe and difficult-to-treat asthma in adults. N Engl J Med. 2017;377(10):965-976. https://doi.org/10.1056/NEJMra1608969 PMid:28877019

46. Scurek M, et al. A narrative review of theophylline: is there still a place for an old friend? J Thorac Dis. 2024;16(6):4065-4080. https://doi.org/10.21037/jtd-23-1781 PMid:38883616 PMCid:PMC11170423

47. Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018;11:193-204. https://doi.org/10.2147/JAA.S176026 PMid:30214247 PMCid:PMC6121746

48. Gyawali B, Georas SN, Khurana S. Biologics in severe asthma: a state-of-the-art review. Eur Respir Rev. 2025;34(175):240088. https://doi.org/10.1183/16000617.0088-2024 PMid:39778920 PMCid:PMC11707604

49. Faria N, Costa MI, Fernandes AL, et al. Biologic therapies for severe asthma: current insights and future directions. J Clin Med. 2025;14(9):3153. https://doi.org/10.3390/jcm14093153 PMid:40364184 PMCid:PMC12072268

50. Menzella F, Lusuardi M, Galeone C, Zucchi L. Tailored therapy for severe asthma. Multidiscip Respir Med. 2015;10:1. https://doi.org/10.1186/2049-6958-10-1 PMid:25671117 PMCid:PMC4323120

51. Kolbeck R, Kozhich A, Koike M, et al. MEDI-563, a humanized anti-IL-5 receptor-α monoclonal antibody with enhanced antibody-dependent cell-mediated cytotoxicity function. J Allergy Clin Immunol. 2010;125(6):1344-1353.e2. https://doi.org/10.1016/j.jaci.2010.04.004 PMid:20513525

52. Menzies-Gow A, Corren J, Bourdin A, et al. Tezepelumab in adults and adolescents with severe, uncontrolled asthma. N Engl J Med. 2021;384(19):1800-1809. https://doi.org/10.1056/NEJMoa2034975 PMid:33979488 PMCid:PMC9166326

53. Rattu A, Dixey P, Charles D, et al. Predictors of response to biologics for severe asthma: a systematic review and meta-analysis. Allergy. 2026;81(1):24-55. https://doi.org/10.1111/all.70031 PMid:40956008 PMCid:PMC12773690

54. Hanania NA, Alpan O, Hamilos DL, et al. Omalizumab in severe allergic asthma inadequately controlled with standard therapy. Ann Intern Med. 2011;154(9):573-582. https://doi.org/10.7326/0003-4819-154-9-201105030-00002 PMid:21536936

55. Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014;371(13):1198-1207. https://doi.org/10.1056/NEJMoa1403290 PMid:25199059

56. Castro M, Zangrilli J, Wechsler ME, et al. Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet Respir Med. 2015;3(5):355-366. https://doi.org/10.1016/S2213-2600(15)00042-9 PMid:25736990

57. Nair P, Wenzel S, Rabe KF, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376(25):2448-2458. https://doi.org/10.1056/NEJMoa1703501 PMid:28530840

58. Rabe KF, Nair P, Brusselle G, et al. Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma. N Engl J Med. 2018;378(26):2475-2485. https://doi.org/10.1056/NEJMoa1804093 PMid:29782224

59. Agustí A, Bel E, Thomas M, et al. Treatable traits: toward precision medicine of chronic airway diseases. Eur Respir J. 2016;47(2):410-419. https://doi.org/10.1183/13993003.01359-2015 PMid:26828055

60. McDonald VM, Gibson PG. Treatable traits in asthma: moving beyond diagnostic labels. Med J Aust. 2022;216(7):331-333. https://doi.org/10.5694/mja2.51464 PMid:35342966 PMCid:PMC9313553

61. Yue M, Tran H, Davidson D, et al. Omics approaches in asthma research: challenges and opportunities. J Allergy Clin Immunol Glob. 2024;3:100192. https://doi.org/10.1016/j.pccm.2024.02.002 PMid:39170962 PMCid:PMC11332849

62. Ortega VE, Meyers DA. Pharmacogenetics: implications of race and ethnicity on defining genetic profiles for personalized medicine. J Allergy Clin Immunol. 2014;133(1):16-26. https://doi.org/10.1016/j.jaci.2013.10.040 PMid:24369795 PMCid:PMC3933289

63. Farzan N, Vijverberg SJH, Andiappan AK, et al. Rationale and design of pharmacogenomic studies of asthma treatment response. Pharmacogenomics. 2020;21(9):591-604.

64. Wechsler ME, Ruddy MK, Pavord ID, et al. Efficacy and safety of itepekimab in patients with moderate-to-severe asthma. N Engl J Med. 2021;385(18):1656-1668. https://doi.org/10.1056/NEJMoa2024257 PMid:34706171

65. Kelsen SG, Agache IO, Soong W, et al. Astegolimab, an anti-ST2, in chronic severe asthma: the ZENYATTA randomized clinical trial. J Allergy Clin Immunol. 2021;148(3):790-798. https://doi.org/10.1016/j.jaci.2021.03.044 PMid:33872652

66. Brightling CE, Gaga M, Inoue H, et al. Effectiveness of fevipiprant in reducing exacerbations in patients with severe asthma: the LUSTER-1 and LUSTER-2 randomized clinical trials. Lancet Respir Med. 2021;9(1):43-56. https://doi.org/10.1016/S2213-2600(20)30412-4 PMid:32979986

67. Kaplan A, Cao H, FitzGerald JM, et al. The emerging role of digital health in the management of asthma. Ther Adv Respir Dis. 2023;17:17534666231215235. https://doi.org/10.1177/20406223231209329 PMid:38028951 PMCid:PMC10657529

68. Jackson DJ, Bacharier LB, Gergen PJ, et al. Twice-yearly depemokimab in severe asthma with an eosinophilic phenotype. N Engl J Med. 2024;391:2337-2349. https://doi.org/10.1056/NEJMoa2406673 PMid:39248309

69. Ferreira MAR, Vonk JM, Baurecht H, Marenholz I, Tian C, Hoffman JD, et al. Shared genetic origin of asthma, hay fever and eczema elucidates allergic disease biology. Nat Genet. 2017;49(12):1752-1757. https://doi.org/10.1038/ng.3985 PMid:29083406

70. Haldar P, Pavord ID, Shaw DE, Berry MA, Thomas M, Brightling CE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008;178(3):218-224. https://doi.org/10.1164/rccm.200711-1754OC PMid:18480428

71. Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, et al. European Respiratory Society guidelines for the diagnosis of asthma in adults. Eur Respir J. 2022;60(3):2101585. https://doi.org/10.1183/13993003.01585-2021 PMid:35169025

72. Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. Eur Respir J. 2022;59(1):2102730. https://doi.org/10.1183/13993003.02730-2021 PMid:34667060

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Sanjeyan N, Karthickkishore P, Avin M, Hari Haran KS. Asthma: Current Concepts in Pathogenesis, Precision Medicine and Emerging Therapeutic Strategies. J. Drug Delivery Ther. [Internet]. 2026 Sep. 15 [cited 2026 Sep. 15];16(9):119-30. Available from: https://www.jddtonline.info/index.php/jddt/article/view/7934

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Vol. 16 No. 9 (2026): Volume 16, Issue 9, September 2026

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Review

Copyright (c) 2026 N Sanjeyan, P Karthickkishore, M Avin , K S Hari Haran

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Sanjeyan N, Karthickkishore P, Avin M, Hari Haran KS. Asthma: Current Concepts in Pathogenesis, Precision Medicine and Emerging Therapeutic Strategies. J. Drug Delivery Ther. [Internet]. 2026 Sep. 15 [cited 2026 Sep. 15];16(9):119-30. Available from: https://www.jddtonline.info/index.php/jddt/article/view/7934
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