Individualized precision therapy for severe asthma: clinical applications of biological agents and frontiers of cell therapy

The management of bronchial asthma has evolved from a one-size-fits-all approach to the era of precision medicine, which is guided by intrinsic phenotypes. This article systematically reviews the mechanisms of action of current targeted biologics (targeting pathways such as IgE, IL-5/IL-5R, IL-4/IL-13, and TSLP), the efficacy and safety data derived from pivotal clinical trials, and the biomarker systems that guide clinical decision-making, further elaborating on how to implement tailored individualized therapy based on patient-specific characteristics. However, existing biologics still face challenges including the need for long-term administration and the inability to reverse disease progression. Therefore, this article focuses on the transformative prospects of next-generation therapeutic modalities. Cell therapy represents the most promising breakthrough, with its core shifting from “passive suppression” to “active regulation and remodeling”. This is mainly reflected in three cutting-edge areas: cellular reprogramming (e.g., converting pathogenic Th2 cells into homing-competent regulatory T cells), engineering modification (e.g., designing CAR-NK cells with dual functions of targeted clearance and immune regulation), and multifunctional immune/repair modulation (e.g., utilizing mesenchymal stem cells and their exosomes to suppress immune abnormalities at the source and promote tissue repair). Collectively, these strategies drive a fundamental shift in treatment goals from symptom control to the induction of long-term immune tolerance and even functional cure. In conclusion, the future management of asthma will be a dynamically evolving individualized integrated system. By deeply integrating targeted biologics, intelligent advanced cell therapies, and continuously optimized precision management strategies, we are expected to ultimately establish a multi-level, closed-loop diagnosis and treatment pathway for each patient, laying the foundation for achieving long-term high-quality remission.