Treatment approaches for the patient with T2 low asthma

Abstract Objective To identify treatment approaches that can be used in the management of patients with asthma who lack significant type 2 inflammation, also called T2 low asthma. Data Sources Recent expert guideline updates on the management of asthma, recent journal articles and review articles, and foundational journal articles are referenced. Study Selections This review cites clinical cohort studies of highly characterized patients with asthma, clinical interventional trials of high impact, mechanistic studies relevant to T2 low asthma, and emerging work in this area. Results T2 low asthma accounts for approximately one-third to one-half of individuals with asthma. Characteristics of participants with T2 low asthma include higher body mass index, cigarette smoking/smoke exposure, relative lack of responsiveness to steroids, less bronchodilator reversibility, and often the presence of neutrophilic inflammation. Multiple available interventions target these characteristics, including standard inhalers, azithromycin, and lifestyle interventions of weight loss and smoking cessation. Conclusion Treatment of T2 low asthma should involve currently available approaches and will benefit from improved definition and understanding of disease pathobiology.