Diseases & Longevity · File 25

Asthma. The most prevalent chronic respiratory disease — redefined by GINA and with systemic cluster.

Asthma affects approximately 262 million people worldwide (Lancet GBD 2019). It's a chronic inflammatory airway disease with phenotypic heterogeneity (T2-high, T2-low, neutrophilic, mixed). GINA 2024 redefined management: ICS-formoterol as rescue, not SABA alone. In severe T2-high asthma, biologics (anti-IL5, anti-IgE, anti-IL4/13, anti-TSLP) changed prognosis. And cluster comorbidities — obesity, OSA, rhinitis, GERD, anxiety — are where longevity medicine operates.

Why asthma is a cluster disease, not just a bronchial one

Asthma was classically taught as reversible airway obstruction — bronchospasm, hyperreactivity. Modern conceptualization is richer: chronic inflammatory disease with phenotypic heterogeneity. T2-high phenotypes (eosinophilic, atopy, elevated IgE, elevated FeNO) respond to inhaled corticosteroids and targeted biologics. T2-low phenotypes (neutrophilic, paucigranulocytic, obesity-associated) respond worse to corticosteroids — require a different view.

Furthermore, asthma is rarely alone: obesity, obstructive sleep apnea, allergic rhinitis, GERD, and anxiety are frequent comorbidities that amplify symptom control. GINA 2024 formalized the change: SABA alone is no longer recommended as rescue due to mortality associated with isolated use — ICS-formoterol is preferred as rescue (track 1) or SABA + ICS (track 2). Modern management integrates cluster.

Asthma is not just a bronchial problem — it's systemic disease with comorbidity cluster. Treating it in isolation is losing control.
5-10% of total · high burden

The global weight, in numbers

Data come from GBD, GINA, ENFUMOSA, and biologic meta-analyses. The management transformation in the last decade is significant.

  • Global prevalence

    ~262M

    Approximately 262 million people live with asthma globally — uneven distribution across regions. Asthma remains a frequent cause of pediatric hospitalization and ambulatory burden in adults.
    — GBD 2019 Lancet Respir Med

  • GINA 2024 redefines rescue

    ICS-formoterol > SABA solo

    GINA 2024: no longer recommends SABA alone as rescue. Preferred strategy is ICS-formoterol as rescue (track 1: MART). Reason: isolated SABA use is associated with higher asthma mortality (Reddel 2024).
    — GINA 2024 Strategy Report

  • Biologics in severe T2 asthma

    Omalizumab → mepolizumab → tezepelumab

    Anti-IgE (omalizumab), anti-IL5 (mepolizumab, reslizumab, benralizumab), anti-IL4/13 (dupilumab), and anti-TSLP (tezepelumab) — have transformed severe T2-high asthma prognosis. They reduce exacerbations, admissions, and sustained oral corticosteroid use.
    — Menzies-Gow et al., NEJM 2021

  • Mortality remains high

    Subutilización tratamiento

    Despite advances, ~455,000 people die annually from asthma — mostly preventable. ICS underutilization, isolated SABA use, and lack of patient education are main contributors.
    — GBD 2019

Chap. 03 · Asthma + obesity + OSA + rhinitis

The comorbidity cluster that amplifies asthma

Asthma is rarely alone. Its control depends on management of systemic comorbidities that amplify it.

  • Obesity

    Asma-obesidad fenotipo

    Central obesity is associated with worse asthma control, higher medication use, and lower corticosteroid response. Weight loss (even modest) significantly improves control. It's a characteristic T2-low cluster phenotype.
    — Holguin et al., Eur Respir J 2018

  • Obstructive sleep apnea (OSA)

    Comorbilidad subdiagnosticada

    OSA frequently coexists with asthma, particularly in obesity. Untreated OSA worsens asthma control and increases exacerbations. CPAP improves both. Polysomnography indicated in clinical suspicion.
    — Salles et al., Eur Respir Rev 2013

  • Allergic rhinitis and polyposis

    United airways

    Allergic rhinitis coexists with asthma in >70% of T2-high cases. Intranasal treatment improves bronchial control ("united airways" concept). Nasal polyposis with severe eosinophilic asthma is indication for biologic evaluation.
    — Bachert et al., Lancet 2019

  • Anxiety and depression

    Bidireccional

    Anxiety and depression are frequent asthma comorbidities — particularly in poor control. The relationship is bidirectional. Addressing mental health improves adherence, symptom control, and quality of life.
    — Lavoie et al., Respir Med 2006

What we don't offer — and what we do

Wellness Care does not prescribe biologics (omalizumab, mepolizumab, dupilumab, tezepelumab) nor manages acute asthma crises. Decision to start inhaled corticosteroids or biologics, GINA titration, and management of severe asthma patients are pulmonology / allergology competence. What we do: integrated cluster evaluation (obesity, OSA, rhinitis, GERD, anxiety), systemic approach, and inter-specialty coordination.

We evaluate patients with poorly controlled asthma despite pulmonology management, asthma with unaddressed cluster comorbidities (central obesity, OSA suspicion, chronic rhinitis, GERD, anxiety or depression), frequent SABA-alone use (concerning per GINA 2024), or patients wanting to understand their phenotype (T2-high vs T2-low) and respiratory longevity trajectory. Coordination with pulmonology, allergology, ENT, gastroenterology, and mental health when indicated.

Modern asthma control is not just a bronchodilator — it's systemic cluster management. That integration is where respiratory longevity complements.
How we measure it

How asthma is evaluated
at Wellness Care

Integrated cluster — phenotype + comorbidities + modifiable factors + coordination with pulmonology and allergology. That integration changes real control.

Advanced biomarkers

21 specialized panels across 8 clinical categories — biological age, inflammaging, metabolic profile, functional hormonal, microbiota. The quantitative layer.

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Functional medicine

Shared root causes — mitochondrial dysfunction, inflammaging, neuroendocrine dysregulation — before organ pathology.

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Bioregulatory medicine

Autonomic regulation, HRV, stress response. The functional trajectory that precedes clinical diagnosis.

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The Longevity Program

How this assessment integrates into the full program — from initial valuation to individualized protocol design under medical judgment.

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Featured evidence

Key evidence supporting this approach

Four publications structuring modern management — GINA 2024, T2 biologics, obesity-asthma phenotype, comorbidities.

«GINA 2024 redefinió el rescate en asma — ICS-formoterol preferido sobre SABA solo debido a la mortalidad asociada al uso aislado de SABA.»
GINA · 2024
GINA 2024 Strategy Report
Redefinición del rescate
«Tezepelumab — anti-TSLP — reduce exacerbaciones en asma severa con eficacia independiente del nivel de eosinófilos sanguíneos.»
NEJM · 2021
Menzies-Gow et al., NEJM 2021
Biologico en asma severa
«El asma-obesidad es un fenotipo distintivo — peor control, menor respuesta a corticoides, y mejora significativa con pérdida de peso.»
Eur Respir J · 2018
Holguin et al., Eur Respir J 2018
Fenotipo asma-obesidad

Frequently asked questions about asthma

The most recurrent questions about asthma — GINA 2024, phenotypes, biologics, comorbidities, and why longevity medicine complements pulmonology.

01

Why did GINA 2024 change the rescue?

Because isolated SABA use (short-acting bronchodilator — salbutamol) is associated with:

· Higher asthma mortality
· Worse inflammatory control

SABA alone treats acute bronchospasm but not the underlying inflammation.

GINA 2024 now prefers ICS-formoterol as rescue and maintenance (track 1: MART — Maintenance and Reliever Therapy).

That strategy reduces severe exacerbations more than SABA alone.

02

What is the T2-high phenotype and why does it matter?

T2-high means type 2 inflammation:

· Eosinophilic
· Atopic
· Elevated IgE
· Elevated FeNO (exhaled nitric oxide)

It's the most frequent phenotype — responds well to inhaled corticosteroids and targeted biologics.

T2-low (neutrophilic, obesity-associated, paucigranulocytic):

· Responds worse to corticosteroids
· Requires different view

Determining phenotype changes management, particularly in severe asthma where it justifies specific biologics.

03

Does obesity really worsen asthma?

Yes, significantly.

Central obesity is associated with:

· Worse asthma control
· Higher medication use
· Higher exacerbation frequency
· Lower response to inhaled corticosteroids

Multifactorial mechanism:

· Systemic inflammation
· Mechanical thoracic alteration
· OSA and GERD comorbidity

Weight loss (even modest — 5-10%) significantly improves control, symptoms, and therapy response.

04

When are biologics considered in asthma?

Biologics are indicated in severe asthma:

· Uncontrolled with high-dose ICS + LABA (GINA step 5)
· With identifiable phenotype
· With frequent or sustained oral corticosteroid use

Choice by phenotype:

· Omalizumab (anti-IgE) — allergic
· Mepolizumab / reslizumab / benralizumab (anti-IL5) — eosinophilic
· Dupilumab (anti-IL4/13) — eosinophilic with atopic dermatitis or nasal polyposis
· Tezepelumab (anti-TSLP) — any severe phenotype

Pulmonology / allergology decision.

05

When should I consult?

A structured assessment is worthwhile if:

· Poorly controlled asthma — frequent SABA use, nocturnal awakenings, activity limitation
· Asthma with suspected unaddressed comorbidities — central obesity, OSA suspicion, chronic rhinitis, GERD, anxiety / depression
· Isolated SABA-alone use (concerning per GINA 2024)
· Want to understand your phenotype and optimize the respiratory longevity view

The assessment complements pulmonology / allergology — does not replace them.

The systemic respiratory cluster

Asthma is not just a bronchial problem — it's systemic disease with comorbidity cluster. Treating it in isolation is losing control.

Identify phenotype, integrate comorbidities (obesity, OSA, rhinitis, GERD, anxiety), follow GINA 2024 (no SABA alone), and coordinate with pulmonology, allergology, ENT, gastroenterology, and mental health — that changes real control.

Poorly controlled asthma or frequent SABA use?

Book a comprehensive asthma and systemic comorbidity assessment

We evaluate clinical history, symptom control (ACT/ACQ), spirometry, inflammatory profile (eosinophils, IgE, FeNO when applicable), cluster comorbidities (obesity, OSA, rhinitis, GERD, anxiety), and 14 Lancet Commission factors when applicable. The assessment does not replace pulmonology / allergology — it complements them.

Book respiratory assessment