Asthma unravelled: a comprehensive review of epidemiology, phenotypes, pathophysiology, and emerging therapies

Abstract Objective To synthesize current evidence on the epidemiology, phenotypes, pathophysiological mechanisms, comorbidities, and management of asthma, with a focus on personalized care and future research directions. Data sources A narrative review of peer-reviewed literature from databases including PubMed, Scopus, and Google Scholar was conducted using keywords such as “asthma,” “phenotypes,” “management,” and “comorbidities.” Study selection and extraction Inclusion criteria emphasized recent studies on asthma classification, emerging therapies, and comorbid conditions. Data were thematically synthesized. Results Asthma is a heterogeneous disease affecting over 260 million people globally. Classification based on clinical presentation (e.g., exercise-induced, occupational), inflammatory phenotype (eosinophilic vs. neutrophilic), and severity enables more targeted management. Key immune pathways involve Th2-mediated eosinophilic inflammation and Th17-driven neutrophilic responses. Comorbidities including obesity, gastroesophageal reflux disease (GERD), anxiety, and depression substantially affect disease control and quality of life. Biologic therapies targeting IgE, IL-5, and IL-4/13 have shown promising results in severe asthma, with differential efficacy across phenotypes. Non-pharmacological strategies such as weight control, breathing exercises, and psychological interventions enhance overall management. Conclusions A nuanced understanding of asthma heterogeneity is essential for optimizing diagnosis and treatment. Future research should focus on endotype-specific biomarkers, early intervention strategies, and integrated care models. Implications for practice and research Clinicians should incorporate phenotype-based approaches and screen for psychiatric comorbidities using validated tools such as Asthma Control Test (ACT) and Hospital Anxiety and Depression Scale (HADS). Research should prioritize personalized therapies, digital monitoring, and the integration of psychosocial interventions in routine care. Graphical Abstract