Current management of severe asthma relying either on guidelines (bulk approach) or on disease phenotypes (stratified approach) did not improve the burden of the disease. Several severe phenotypes are described: clinical, functional, morphological, inflammatory, molecular and microbiome-related. However, phenotypes do not necessarily relate to or give insights into the underlying pathogenetic mechanisms which are described by the disease endotypes. Based on the major immune-inflammatory pathway involved type-2 high, type-2 low and mixed endotypes are described for severe asthma, with several shared pathogenetic pathways such as genetic and epigenetic, metabolic, neurogenic and remodelling subtypes. The concept of multidimensional endotyping as un unbiased approach to severe asthma is discussed, together with new tools and targets facilitating the shift from the stratified to the precision medicine approach.

目前依靠指南（批量方法）或疾病表型（分层方法）治疗严重哮喘并不能改善疾病负担。描述了几种严重的表型：临床，功能，形态，炎症，分子和微生物组相关。然而，表型并不一定与疾病内型所描述的潜在致病机制有关或对它们有所了解。基于严重的哮喘所涉及的主要免疫炎症途径，描述了严重哮喘的2型高，2型低和混合内型，以及几种共有的致病途径，例如遗传和表观遗传，代谢，神经源和重塑亚型。讨论了多维内向型作为无偏见治疗严重哮喘的方法的概念，