Semin Respir Crit Care Med 2012; 33(06): 577-578
DOI: 10.1055/s-0032-1326958
Preface
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Asthma

J. Christian Virchow
1   Abteilung für Pneumologie, Intensive Care Medicine, Klinik I, Zentrum für Innere Medizin, Universität Rostock, Rostock, Germany
,
Peter J. Barnes
2   National Heart and Lung Institute, Imperial College of Medicine, London, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
09 October 2012 (online)

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Asthma remains a major health issue around the world where its incidence and prevalence are still increasing in many countries. Despite a general perception that the problem of treating asthma is “solved” many patients are undertreated by current “one-size-fits-all” approaches to asthma treatment. This issue of Seminars in Respiratory and Critical Care Medicine reviews current trends and future developments in the pathophysiology, diagnosis, and treatment of asthma that are likely to be of clinical importance.

Airway hyperresponsiveness, which is the most specific pathophysiological characteristic of asthma, is highlighted in the first article, and new concepts about neuronal mechanisms in its pathogenesis are addressed.

There are increasing efforts to subphenotype and possibly endotype asthma to eventually achieve a personalized approach to treatment. Aspirin-exacerbated respiratory disease, formally referred to as aspirin-sensitive asthma, is one clinically important phenotype. Although its pathogenesis is now better understood, it requires a special approach to therapy and is an early example of personalized medicine in asthma, so this topic is covered in a separate article in this issue.

Recently it has become evident that other clinical conditions may masquerade as asthma. There are several conditions, such as vocal cord dysfunction syndrome, which may not only mimic but also complicate coexisting asthma. Vocal cord dysfunction syndrome and other conditions of dysfunctional breathing are therefore also addressed in this issue.

The increasingly recognized role of air pollution in the pathogenesis of asthma, as well as its role in aggravating asthmatic symptoms, is also covered here.

Current and future attempts to subphenotype asthma as well as the search for clinically reliable biomarkers that are clinically accessible are other important topics for this issue. Asthma and pregnancy is discussed, with an emphasis on treatment approaches to reduce the risk of asthma crisis in asthmatic mothers as well as birth defects in their children. Current and possibly future attempts to cluster asthma patients to improve the understanding of asthma phenotypes as a prerequisite to a phenotype-driven, individualized asthma treatment are also discussed. This is complemented by a timely article on occupational asthma. The occupational exposure to allergens and sensitizing chemicals is often overlooked and may account for a considerable number of cases. This could be one of the reasons for suboptimal outcomes in asthma treatment and may also contribute to the increasing worldwide prevalence of asthma.

Finally, two articles are devoted to the clinical challenge of severe, persistent asthma and current approaches to its management, as well as an up-to-date review of future developments that hold great promise for asthma treatment in well-characterized subgroups of patients.

Overall this global collection of review articles on current and future trends in asthma diagnosis and management is of value to pulmonary specialists and general practitioners interested in the diagnosis and treatment of asthmatic patients, as well as providing a clinical perspective for those involved in basic research into asthma and the development of new asthma therapies. It is likely that asthma treatment in the future will change from a “blockbuster” drug approach to an individualized, phenotype-driven management protocol.

We are very grateful to the global panel of experts who were willing to share their expertise in this developing field. It is our hope that this issue will serve as a useful resource for clinicians in the diagnosis and management of patients with asthma.