Asthma affects over 250 million people and is responsible for over 20 million disability-adjusted life years. Worldwide 5%–10% suffer from severe persistent symptoms and contribute to the majority of healthcare utilization associated with the disease. Severe exacerbations requiring emergency management, lung function decline risk and quality of life may affect patients with poorly controlled asthma. In addition to non pharmacological interventions, various pharmacological therapies are currently available to help manage severe asthma, including biological therapies for patients with elevated markers of type 2 inflammation.
Severe asthma is a heterogeneous disease phenotypically and biologically, involving various inflammatory cells and cytokines. Recent insights into type 2 inflammation in severe asthma and the current available biologic treatment including their mechanism of action, efficacy and association with specific phenotypes and comorbidities will be reviewed.