Asthma is a heterogeneous chronic inflammatory airways disease that affects more than
325 million people worldwide. Of these, approximately 10% have severe asthma that is refractory to
commonly available treatments. In the past 15 years, there have been substantial advances in the
understanding of asthma pathophysiology that have allowed for the development of targeted
biological treatments such as omalizumab and mepolizumab in patients with severe asthma. On the
horizon, several new classes of asthma treatments, specifically biological modulators of interleukin-4
(IL)-4, IL-5, IL-13, IL-33, and thymic stromal lymphopoietin (TSLP), are in both early and late
phases of development or going through regulatory approval. Successes have also been met with
failures, namely in targeting IL-17 and neutrophil-high asthma. This likely reflects knowledge gaps in
the pathophysiology of non-eosinophilic and corticosteroid insensitive asthma. New treatment options
are vital to patients with severe asthma who fall outside the indications for new biologic therapies or
for those that have failed to respond. This review article shall be limited to a discussion on available
and emerging biological treatment options in severe asthma and bronchial thermoplasty.
Keywords: Asthma, biologics, bronchial thermoplasty, monoclonal antibodies, novel agents, severe asthma.
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