Using Asthma Phenotypes and Endotypes to Guide Treatment in Pediatric Asthma.

Understanding asthma phenotypes, including asthma severity and presence of type 2 (T2) inflammation, can help guide a personalized approach to treatment. Clinically accessible biomarkers, such as blood eosinophils, fractional exhaled nitric oxide, and immunoglobulin E, can help to differentiate between T2-high and non-T2 asthma phenotypes. For mild-to-moderate asthma, inhaled corticosteroids are the mainstay with best response in T2-high asthma. The addition of a long-acting β2-agnoist, however, is the best step-up option for most patients regardless of phenotype. Anti-inflammatory and single maintenance and reliever therapies are also emerging treatment options. For severe asthma, T2 status can guide biological treatment.