ArticleThe journal of allergy and clinical immunology. Global2026
Phenotyping treatment-naive uncontrolled asthma in adults: A primary care framework.
Article in The journal of allergy and clinical immunology. Global, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Initial asthma management often relies on a one-size-fits-all approach; however, the heterogeneity of treatment-naive, uncontrolled asthma remains insufficiently characterized. Specifically, the complex relationships among symptom burden, type 2 (T2) inflammation, and pulmonary function in this population are poorly understood. Objective: We sought to identify distinct clinical phenotypes in treatment-naive adults via multidimensional analysis and evaluate the association between symptom scores and T2 inflammation. Methods: This single-center, retrospective study analyzed 171 treatment-naive adults with uncontrolled asthma (5-item Asthma Control Questionnaire [ACQ-5] score ≥ 1.5). We performed k-means clustering using 20 variables, including demographics, symptoms, T2 biomarkers (blood eosinophils and fractional exhaled nitric oxide), and lung function (FEV Results: Cluster analysis identified 3 phenotypes: relative T2-low/preserved function (32.7%); severe T2/obstructive (29.2%); and (3) T2-moderate/small airway dysfunction predominant (38.0%). The prevalence of T2-high status varied significantly (30.4%, 64.0%, and 50.8%, respectively; Conclusions: In this study population, treatment-naive uncontrolled asthma comprises 3 clinically distinct phenotypes with divergent inflammatory and functional profiles. Symptom burden alone appeared to be a limited predictor of T2-high inflammation. These exploratory findings suggest that incorporating objective biomarkers and functional assessments into initial care may help tailor therapeutic strategies for patients with small airway dysfunction or discordant symptom-inflammation profiles. Further validation in larger cohorts is required.
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