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Asthma phenotyping and endotyping has emerged as a novel approach to asthma classification inspired by precision medicine which separates the clinical presentations of asthma, or asthma phenotypes, from their underlying causes, or asthma endotypes. The best-supported endotypic distinction is the type 2-high/type 2-low distinction.
Asthma is a common pulmonary condition defined by chronic inflammation of respiratory tubes, tightening of respiratory smooth muscle, and episodes of bronchoconstriction. [1] The Centers for Disease Control and Prevention estimate that 1 in 11 children and 1 in 12 adults have asthma in the United States of America. [ 1 ]
Pulmonary function testing is a safe procedure; however, there is cause for concern regarding untoward reactions and the value of the test data should be weighed against potential hazards. Some complications include dizziness, shortness of breath, coughing, pneumothorax, and inducing an asthma attack. [13] [14]
However, in asthma, the airflow limitation usually completely resolves after exacerbations, whereas in COPD it may not. [1] ACO presents with a chronic airflow limitation or obstruction (due to inflammation), with characteristics of both asthma and COPD. Inflammation of the large and medium airways (classically seen with asthma) is seen in ACO. [1]
In the UK, approximately 1 in 7 individuals are affected by some form of chronic lung disease, most commonly chronic obstructive pulmonary disease, which includes asthma, chronic bronchitis and emphysema. [32] Respiratory diseases (including lung cancer) are responsible for over 10% of hospitalizations and over 16% of deaths in Canada. [33]
Due to the chronic nature of this disease, the leading symptom of restrictive lung disease is progressive exertional dyspnea. [3] For acute on chronic cases, shortness of breath , cough , and respiratory failure are some of the more common signs.
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The 2005 Oxford Textbook of Medicine distinguishes type 1 brittle asthma by "persistent daily chaotic variability in peak flow (usually greater than 40 per cent diurnal variation in PEFR more than 50 per cent of the time)", while type 2 is identified by "sporadic sudden falls in PEFR against a background of usually well-controlled asthma with normal or near normal lung function". [8]
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