Modern methods of diagnosis and treatment of severe bronchial asthma (systematic review)

Currently, the prevalence of bronchial asthma (BA) is steadily increasing worldwide. Official statistics show that severe BA accounts for 5–10% of cases in the severity profile of this disease, and when treated with high doses of corticosteroids, uncontrolled symptoms persist in most people, which significantly reduces their quality of life. This supports the relevance of finding new strategies for the treatment of severe BA. The aim of the review was to analyze and summarize published data on modern approaches to the diagnosis and treatment of severe BA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 3,177 sources were found. Excluding publications that were unavailable for viewing allowed us to leave 578 sources, of which 120 papers were relevant to the study topic to some extent. Of these, 63 sources were selected that contained the information necessary for the study and met the selection criteria for the studies: 28 of them were review articles and 35 were original studies (randomized controlled, cohort, and case-control studies). The work presents a description of phenotypes and endotypes, as well as characteristics of modern biomarkers of severe BA. Particular attention is paid to a new approach to the treatment of severe BA. The conducted studies, systematized in this article, indicate that a detailed description of asthma phenotypes and endotypes can help identify new biomarkers and therapeutic targets specific to each endotype. Profound knowledge of the patient’s phenotype and endotype can determine a personalized approach to the treatment of severe BA.