Precision medicine as the new frontier for asthma treatment

Asthma is a complex, heterogeneous disease that necessitates a proper patient evaluation to choose the most appropriate treatment and optimize disease control. The recent introduction of new target therapies for the most severe form of the disease has heralded a new era of treatment options, targeting specific molecular pathways in asthma pathophysiology. Many factors could contribute to lack of disease control and several biological markers (e.g. blood eosinophils, IgE, FeNO) have been identified that are associated with disease subtypes or disease activity. However, we still do not have accurate clinically available biomarkers to distinguish different immunoprofiles of asthma patients and guide proper and personalized treatment. Therefore, a better refinement of phenotypes and biomarkers is necessary. Understanding the molecular mechanisms behind the heterogeneity of asthma phenotypes is essential for the identification of novel biomarkers that are reliable and easy to measure.
The thesis is divided into 4 parts: the first part is the introduction of this thesis, and provides an overview of the current role of precision medicine in asthma, with a specific focus on new technologies such as the analysis of exhaled breath through the eNose (Chapters 1 and 2). The second part (Chapters 3-5) focuses the identification of potential new asthma biomarkers, such as exhaled breath profiles and surfactant protein D (SP-D) in blood. The third part (Chapters 6 and 7) addresses currently available anti-IL5 biologic therapies for severe asthma and predictive markers of response or non response to biologics. It also investigates the potential discrepancies between the population studied in clinical trials and the population that uses biologics in routine clinical care. The fourth part (Chapter 8) includes the general discussion of this thesis. New technologies (eNose) and biomarkers (SP-D) might be applicable in a future real-life setting, this thesis explore their potential and their limitations, as well as the future directions and treatment perspective in asthma research.