A new study using metabolomic profiling has identified three distinct biological subtypes of asthma in patients who appear to be clinically stable. Despite similar symptom control and exacerbation history, these subgroups showed significant differences in lung function, airway structure, and immune activity.
Researchers analyzed blood plasma from adults with well-controlled asthma on inhaled corticosteroids. Using consensus clustering, they identified three endotypes:
- Remodeling-prone (C1): Higher glycerophospholipid metabolites, lower lung function, thicker airway walls, and elevated innate lymphoid cells, indicating ongoing structural changes.
- Biologically stable (C2): Preserved airway structure and higher lung function, suggesting truly controlled disease.
- T2-high (C3): Elevated nitric oxide and eosinophils, pointing to type 2 inflammation, though airway structure was relatively preserved.
The findings challenge the current reliance on symptoms and exacerbations to define asthma control. The study suggests that metabolomic profiling could become a valuable tool for precision medicine, helping identify patients at risk of progression even when symptoms are minimal.
Further research is needed to determine if these subtypes predict long-term outcomes or response to targeted therapies.