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Review
. 2025 Sep;156(3):503-522.
doi: 10.1016/j.jaci.2025.03.025. Epub 2025 Apr 7.

Personalized therapeutic approaches for asthma

Ioana Agache  1 , Ian M Adcock  2 , Federico Baraldi  3 , Kian Fan Chung  4 , Ibon Eguiluz-Gracia  5 , Sebastian L Johnston  6 , Marek Jutel  7 , Parameswaran Nair  8 , Alberto Papi  3 , Celeste Porsbjerg  9 , Omar S Usmani  10 , Deborah A Meyers  11 , Magdalena Zemelka-Wiacek  12 , Eugene R Bleecker  13
Affiliations
Review

Personalized therapeutic approaches for asthma

Ioana Agache et al. J Allergy Clin Immunol. 2025 Sep.

Abstract

Differences in host susceptibility and environmental exposures result in significant heterogeneity in asthma clinical expression, natural evolution, and response to treatment. These differences are influenced by many factors including genomics, epigenomics, transcriptomics, proteomics, and metabolomics, many of which are modified by environmental and allergic exposures. The complex and multiple characteristics that interact in asthma development and progression pose significant challenges for personalized management. This review aims to guide the clinician in its management decisions by reviewing each of the components important in developing this therapeutic paradigm and by providing several integrated goals for precision or personalized medicine for asthma. Biologic characteristics of asthma in relation to the genomics, exposome, and hypersensitivity reactions (allergic responsiveness) resulting in asthma diathesis are discussed. Further insights including the use of targeted biologics and allergen immunotherapy are provided, while discussing the importance of targeting the epithelium, mucus production, airway smooth muscle, and small airways. We examine the value of multivariate cluster analyses as a new paradigm that can inform treatment decisions and the potential of adaptive trial design to evaluate known and novel predictive biomarkers and characterize disease heterogeneity.

Keywords: Asthma; biomarkers; endotypes; precision medicine.

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Conflict of interest statement

Disclosure statement Supported by National Institutes of HealthNational Heart, Lung, and Blood Institute (grants HL 146002 and HL 161362 to E.R.B. and D.A.M.). Disclosure of potential conflict of interest: I. Agache reports service as deputy editor for Journal of Allergy and Clinical Immunology and associate editor of Clinical and Translational Allergy. E. R. Bleecker and D. A. Meyers report grants and contracts to the Mayo Clinic from AstraZeneca; personal consulting fees from AstraZeneca; and National Institutes of Health support through grants and contracts. K. F. Chung reports receipt of research grants, paid to his institution, from the UK Research and Innovation Medical Research Council, the UK Research and Innovation Engineering and Physical Sciences Research Council, the US National Institute of Environmental Health Sciences, Merck, and GlaxoSmithKline; has received lecture fees from GlaxoSmithKline, Novartis, and AstraZeneca; has been on advisory boards for Roche, Merck, Novartis, GlaxoSmithKline, AstraZeneca, Trevi, Reckitt, Benkiser, Nocion, and Shionogi; and is on the scientific advisory board of The Clean Breathing Institute, supported by Haleon. M. Jutel reports personal fees from ALK-Abelló, Allergopharma, Stallergenes, Anergis, Allergy Therapeutics, Leti, and HAL during the conduct of the study; personal fees from GSK, Novartis, Teva, Takeda, and Chiesi outside the submitted work; and is deputy editor for Journal of Allergy and Clinical Immunology and associate editor of Clinical and Translational Allergy. S. L. Johnston has received consultancy fees from AstraZeneca, Bioforce, Enanta, Chiesi, and GlaxoSmithKline; has received a research grant from GSK; is an inventor holding patents on the use of inhaled interferons for treatment of exacerbations of airway diseases and on rhinovirus vaccines; and is director and shareholder of Virtus Respiratory Research. C. Porsbjerg reports serving as associate editor of American Journal of Respiratory and Critical Care Medicine; and reports receipt of personal fees and research grants from AstraZeneca, GSK, Novartis, Sanofi, Chiesi, ALK-Abelló, and Teva. The rest of the authors declare that they have no relevant conflicts of interest.