Asthma is a common, multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate for a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies.

1st Respiratory Medicine Dept Hygeia Hospital Athens Greece

AUKCAR Usher Institute University of Edinburgh Edinburgh United Kingdom

Department of Allergy La Paz University Hospital IdiPAZ CIBER of Respiratory Diseases Madrid Spain

Department of Otorhinolaryngology Amsterdam University Medical Centres Amsterdam the Netherlands

Department of Otorhinolaryngology University of Leuven Leuven Belgium; Laboratory of Allergy and Clinical Immunology University of Leuven Leuven Belgium; Upper Airways Disease Laboratory University of Ghent Ghent Belgium

Department of Pediatrics Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Teaching Hospital in Martin Martin Slovakia; Department of Pulmonology and Phthisiology Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Teaching Hospital in Martin Martin Slovakia; Institute of Clinical Immunology and Medical Genetics Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Teaching Hospital in Martin Martin Slovakia

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden

NIHR Oxford Biomedical Research Centre Nuffield Department of Medicine University of Oxford Oxford United Kingdom

NIHR Southampton Biomedical Centre Faculty of Medicine University of Southampton United Kingdom

Section of Pulmonary and Critical Care Medicine Baylor College of Medicine Houston TX

The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members Brussels Belgium

The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members Brussels Belgium; Escuela de Doctorado UAM Centro de Estudios de Posgrado Universidad Autónoma de Madrid Calle Francisco Tomás y Valiente nº 2 Ciudad Universitaria de Cantoblanco Madrid Spain

The Royal National ENT Hospital London United Kingdom; Division of Infection and Immunity University College London United Kingdom

University of Groningen University Medical Center Groningen Department of Clinical Pharmacy and Pharmacology Groningen the Netherlands; Department of Microbiology Immunology and Transplantation KU Leuven Catholic University of Leuven Leuven Belgium; Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Wellcome Wolfson Institute for Experimental Medicine Queen's University Belfast Belfast United Kingdom

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