Pulmonary function and phenotypes in bronchial asthma

Bronchial asthma is a heterogeneous disease with multiple phenotypes that differ in functional characteristics and pathophysiological mechanisms. This paper presents a critical analysis of the relationships between pulmonary function parameters and various clinical phenotypes of asthma. Functional patterns of allergic and non-allergic variants, early-onset and late-onset asthma, eosinophilic and neutrophilic phenotypes are reviewed. It is shown that allergic asthma is characterized by intermittent disturbances with good reversibility, while late-onset asthma demonstrates accelerated decline in lung function and tendency toward remodeling. Particular attention is paid to the role of small airways in disease pathogenesis and the need for specialized methods to assess their function. The significance of inflammatory biomarkers for accurate phenotyping and selection of personalized therapy is discussed. It is emphasized that integration of functional parameters with clinical and molecular data allows optimization of diagnosis, monitoring and treatment of bronchial asthma.

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