• D Hassoun, A Moui, L Colas, F X Blanc, and A Magnan.
• Service de pneumologie, l'institut du thorax, hôpital Guillaume et René LAENNEC, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France; Inserm UMR 1087, CNRS UMR 6291, l'institut du thorax, université de Nantes, 8, quai Moncousu, 44007 Nantes, France. Electronic address: dorian.hassoun@chu-nantes.fr.
• Rev Med Interne. 2019 Aug 1; 40 (8): 508-516.

AbstractAsthma is an inflammatory airway disease which presentation is highly heterogeneous. Last two decades provided new clinical and basic data concerning asthma physiopathology that make global understanding much complex. Phenotypes based on clinical settings and paraclinical investigations from large cohorts confirm old paradigm (eosinophilic vs. non-eosinophilic asthma) but also introduce new concepts (obesity-related asthma, late onset asthma, etc.). Conversely, improvement of big data analytics allows to initiate new cohorts aiming at better understanding the pathophysiology underlying those phenotypes and unraveling new ones. However, clinical and therapeutic impacts of those big data need to be further detailed. In parallel, biotherapies and innovative techniques as bronchial thermoplasty become available for severe asthmatic patients who did not respond to specific treatment in the past. Development of a personalized medicine in severe asthma becomes an important challenge for tomorrow. This review will focus on new pathophysiological concepts arisen from large cohorts and new therapeutic strategies available and in progress for severe asthma.Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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