Beyond T2 mechanisms in asthma: who are the other players?
Hot topicChairs: K. Chung (London, United Kingdom), M. Al-Ahmad (Kuwait, Kuwait), N. Jarjour (Madison, United States of America)
Aims: to identify the unmet need for a valid definition of non-T2 severe asthma; to discuss current definitions and their limitations (including those in the relevant ATS/ERS and GINA guidelines); to emphasise the role of corticosteroids in supressing T2 activity and the need for stepdown trials to define non-T2 disease; to ascertain the role of sex hormones in the pathogenesis of asthma onset, progression and/or exacerbations; to discuss the potential for targeting sex hormones and identifying new pathways that can be exploited for therapeutic interventions; to discuss the role of airway dysbiosis in severe asthma and the potential for targeting the microbiome with antibiotics, probiotics or phage therapies; to review novel clinical trial designs employing complex interventions to treat non-T2 severe asthma, focusing on comparisons with standard of care and methods to integrate these trials into existing monoclonal therapy pathways; to discuss the role of adaptive clinical trials and multi-arm multi-stage trial designs in the context of severe asthma; to highlight parallels with other disciplines such as oncology and rheumatology.