Precision Approaches to Heterogeneity in Asthma

lt;b>Allan R. Brasier, MD, is the Jan and Kathryn Ver Hagen Professor in Translational Research, Senior Associate Dean for Clinical and Translational Research, and Executive Director, Institute for Clinical and Translational Research, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin

Nizar N. Jarjour, MD, is Professor of Medicine and Division Head, Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin

Introduction Part I.- The spectrum of asthma epidemiology.- Disease prevalence and burden.- Climate considerations in asthma and impacts of climate change.- Asthma across the ages: children, women, and the elderly.- Asthma as a systemic disease: neurologic, cardiac and metabolic changes in asthma.- Social determinants of health in asthma.- Part II. Mechanistic heterogeneity in asthma, -Phenotypes and endotypes.- Heterogeneity of treatment response to asthma (including mild-moderate asthma).- Regional airway involvement: Imaging heterogeneity in ventilation, mucus and remodeling.- Biobehavioral determinants of asthma, including CNS influences and dietary/nutrition.- Integrative/ Systems levels studies.- Part III. Severe and difficult to treat asthma endotypes.- Definition, phenotyping of severe asthma, including cluster analysis.- Asthma exacerbations: patient features and potential long-term implications.- Innate inflammation driven remodeling.- Adaptive immunity and remodeling.- PartIV. Influence of heterogeneity on approaches to management.- Approaches to management of asthma.- Guidelines for stepped care and self-monitoring.- Global considerations in asthma treatment - management in low resource settings.- Update on biomarker-driven approaches and precision medicine- adaptive clinical trials e.g., PRECISE.- Conclusion and future directions.