Analysis of current approaches to the diagnosis and treatment of severe bronchial asthma

This review analyzes modern approaches to the diagnosis and treatment of severe bronchial asthma (SBA), characterized by a transition to personalized medicine. The need to improve therapy for SBA is driven by its increasing prevalence and high resource consumption. This study examined the role of genetic polymorphisms in predisposition, disease course, and therapy response. Considerable attention is paid to pharmacogenetics, highlighting key genetic markers that influence the efficacy of basic bronchial asthma drugs (beta-agonists, inhaled corticosteroids, and leukotriene modifiers) and the possibility of personalizing the choice of biological therapy. A significant part of the review focused on monoclonal antibodies (omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab), which represent a targeted approach to the treatment of SBA. The key predictors of treatment effectiveness (e. g., blood eosinophil level, IgE, FeNO, and exacerbation frequency) were analyzed for each group of biological drugs, and the importance of early initiation of therapy was emphasized to achieve maximum effect and prevent airway remodeling. Conclusion: The paradigm shift in SBA management through biological therapy, including achieving clinical remission and reducing the need for systemic corticosteroids, enables effective control in a significant proportion of patients with severe forms of the disease.

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