Severe asthma: Behind the scenes of severe asthma

Abstract

Behind the scenes aspects of severe asthma, that is, what lies behind the genetic, epigenetic, and inflammatory factors that lead our patient to present asthma-related symptoms, disease progression, non-response to inhaled medication tools, and ultimately determine that our patients have severe asthma. In this chapter, we will revisit concepts of genetics and epigenetics and understand the importance of this knowledge, which is often described as specific but must be understood. In addition to this exploration of genetic and epigenetic bases, we will briefly review inflammation in asthma, understanding in a practical way how to classify our patient by identifying the main actors involved in this fantastic immunological interaction. Two other aspects that will be highlighted are the microbiome and the mucus plug. The first directly influences the inflammatory response of asthma and has been increasingly studied. The second is in evidence, and we increasingly understand the role of this likely future biomarker of severe asthma. Now that we understand the purpose of the article, we are ready to delve into the behind the scenes story of this highly prevalent disease, which unfortunately is still responsible for deaths in our country.