Emerging Treatment Options in Severe Asthma

Asthma is a heterogeneous chronic inflammatory airways disease that affects more than 325 million people worldwide. Of these, approximately 10% have severe asthma that is refractory to commonly available treatments. In the past 15 years, there have been substantial advances in the understanding of asthma pathophysiology that have allowed for the development of targeted biological treatments such as omalizumab and mepolizumab in patients with severe asthma. On the horizon, several new classes of asthma treatments, specifically biological modulators of interleukin-4 (IL)-4, IL-5, IL-13, IL-33, and thymic stromal lymphopoietin (TSLP), are in both early and late phases of development or going through regulatory approval. Successes have also been met with failures, namely in targeting IL-17 and neutrophil-high asthma. This likely reflects knowledge gaps in the pathophysiology of non-eosinophilic and corticosteroid insensitive asthma. New treatment options are vital to patients with severe asthma who fall outside the indications for new biologic therapies or for those that have failed to respond. This review article shall be limited to a discussion on available and emerging biological treatment options in severe asthma and bronchial thermoplasty.