Asthma Insights: Biomarkers & Personalised Care

Recent key publications

Asthma Phenotypes and Biomarkers. 
Respire Care 2025; 70:649-674 Grunwell JR, Fitzpatrick AM.

Link to full article:https://pubmed.ncbi.nlm.nih.gov/40013975/

The phenotypic heterogeneity of severe asthma continues to present challenges for clinical management, particularly given that recent advances in precision medicine have transformed therapeutic approaches by identifying type 2-high and type 2-low inflammatory endotypes. While contemporary research has demonstrated that targeted biologic therapies, including anti-IL-5, anti-IL-4/IL-13 and anti-IgE agents, can significantly reduce exacerbation rates in carefully phenotyped patients, substantial knowledge gaps remain regarding the optimal selection of biomarker-guided treatment and the pathobiology of corticosteroid-resistant type 2-low asthma. This comprehensive review summarises the current understanding of adult and paediatric asthma phenotypes, evaluates evidence-based approaches to biologic therapy selection and addresses the important question of whether paediatric intensive care unit admissions represent a distinct, high-risk phenotype that requires specialised management strategies.

Novel biomarkers in asthma. 
Curr Opin Pulm Med 2025; 31:243-250. Agrawal N, Kraft M.

Link to full article:https://pubmed.ncbi.nlm.nih.gov/39950260/

The field of asthma research has reached a transformative juncture, revealing an urgent need for advanced biomarkers that can unravel the disease's complex heterogeneity and guide precision therapeutics. Biologic therapies, particularly anti-IL-5 and anti-IgE monoclonal antibodies, are becoming increasingly central to the management of severe asthma. However, it has been discovered that conventional biomarkers, such as peripheral blood eosinophil counts and fractional exhaled nitric oxide (FeNO), provide an incomplete picture of the underlying inflammatory landscape. This comprehensive analysis explores breakthrough discoveries in next-generation biomarkers, including: eosinophil peroxidase as a marker of eosinophil activation; diverse mast cell mediators that extend beyond traditional tryptase measurements; and Club Cell Protein 16 (CC16) as an indicator of epithelial barrier function. These emerging tools promise to transform our ability to categorise asthma endotypes precisely and to tailor therapeutic interventions to individual patient profiles. With the 2024 Global Initiative for Asthma (GINA) guidelines placing an unprecedented focus on phenotype-directed treatment strategies, this work offers valuable insights for investigators and practitioners seeking to advance personalised medicine in the treatment of severe asthma.

Biomarker Discovery in Childhood Asthma: A Pilot Study of Serum Metabolite Analysis for IgE-Dependent Allergy. 
Med Sci Monit 2025; 31:e948478. Rzetecka N, Matysiak J, Plewa Set al.

Link to full article:https://pubmed.ncbi.nlm.nih.gov/40554458/

Early diagnosis of childhood asthma remains a significant clinical challenge, particularly for children under five, where conventional diagnostic tools are limited and symptom-based assessments are often inadequate. However, recent advances in metabolomics have revealed promising avenues for biomarker discovery, with targeted serum metabolite profiling emerging as a potential solution to address this diagnostic gap in paediatric respiratory medicine. This pilot study shows that specific sphingolipid and glycerophospholipid metabolites, particularly when analysed using multivariate techniques, can distinguish asthmatic children with IgE-dependent allergy from healthy controls with remarkable accuracy. Identifying a novel multiclassifier incorporating phosphatidylcholine 40:4 and serotonin synthesis ratios is a significant step towards precision medicine approaches that could transform early asthma diagnosis and personalised treatment strategies for the most vulnerable paediatric patients.

Assessing serum and biopsy biomarkers for predicting allergic asthma severity: a comprehensive study. 
J Asthma 2025; 62:1119-1127. Mohammed ZK, Smail SW, Janson C, Amin K.

Link to full article:https://pubmed.ncbi.nlm.nih.gov/39932249/

The clinical management of allergic asthma is still hindered by a lack of reliable biomarkers that can accurately predict disease severity and how patients will respond to treatment, particularly as personalised medicine approaches become more important in respiratory care. While traditional assessment methods rely heavily on spirometry and symptom scores, emerging evidence suggests that combined serum and tissue-based biomarker panels may be more effective at identifying patients at risk of severe disease progression. This comprehensive study reveals strong correlations between fibroblast growth factors (particularly FGF-18) and tissue-specific inflammatory markers (such as activated eosinophils) with lung function parameters and asthma severity scores. These findings lay the groundwork for the development of integrated biomarker strategies that could transform clinical decision-making by enabling the earlier identification of high-risk patients and facilitating more precise therapeutic interventions in the management of allergic asthma.

Gene-by-environment interactions modulate the infant gut microbiota in asthma and atopy. 
J Allergy Clin Immunol. 2025 Apr 3:S0091-6749(25)00368-9. Stickley SA, Fang ZY, Ambalavanan Aet al.

Link to full article:https://pubmed.ncbi.nlm.nih.gov/40187613/

The growing global impact of paediatric asthma and atopic diseases makes it urgent to understand the factors that determine health in early life, especially given the increasing evidence that infant gut microbiota play a key role in immune system development. This pioneering study uses the CHILD Cohort Study to show how gene-environment interactions influence microbial communities in the first year of life. It reveals new links between particular genetic variants (MARCO and SMAD2) and microbiota-related disease susceptibility. These findings advance precision medicine approaches by identifying host-microbe interactions that can be targeted to modulate childhood respiratory and atopic outcomes. This offers unprecedented opportunities for early intervention strategies in an era of rising allergic disease prevalence.

What the clinician should know when ordering a mast cell tryptase test: A review article for the North American practicing clinician. 
Ann Allergy Asthma Immunol 2025; 134:649-657. Michel M, Giusti D, Klingebiel Cet al.

Link to full article:https://pubmed.ncbi.nlm.nih.gov/40074077/

Although tryptase measurement has emerged as a critical biomarker for diagnosing mast cell-mediated disorders, rapidly evolving clinical guidelines and expanding genetic insights necessitate updated interpretation frameworks for practitioners. This comprehensive review summarises the latest recommendations on tryptase utilisation, integrating recent advances in the characterisation of hereditary α-tryptasaemia and droplet digital PCR genotyping methodologies. The authors offer invaluable advice on how to distinguish between baseline and acute tryptase elevations, how to interpret results in the context of an individual's genetics, and how to navigate diagnostic algorithms for anaphylaxis, mastocytosis, and emerging mast cell activation syndromes.