Targeting Airway Remodeling in Severe Asthma: Is There a Window of Opportunity for Biologic Therapy Predicting Effects Using Causal Artificial Intelligence?

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Publication Details

Journal
Allergy
Published
2026-08-27
DOI
https://doi.org/10.1111/all.70468
Primary Topic
Asthma and respiratory diseases
Type
article
Field-Weighted Citation Impact
0.00
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article

Targeting Airway Remodeling in Severe Asthma: Is There a Window of Opportunity for Biologic Therapy Predicting Effects Using Causal Artificial Intelligence?

J. Christian Virchow, Giorgio Walter Canonica, Sebastiano Gangemi, Sara Manti
Allergy
Asthma and respiratory diseases
article

Targeting Airway Remodeling in Severe Asthma: Is There a Window of Opportunity for Biologic Therapy Predicting Effects Using Causal Artificial Intelligence?

J. Christian Virchow, Giorgio Walter Canonica, Sebastiano Gangemi, Sara Manti
article en

Abstract

Airway remodeling is increasingly recognized as a major determinant of asthma progression, fixed airflow limitation, and long-term morbidity, particularly in severe disease. Although biologic therapies have transformed outcomes by reducing exacerbations and systemic corticosteroid exposure, their potential to modify structural airway trajectories-and whether a time-sensitive "window of opportunity" exists-remains uncertain. Here, we provide a progressive landscape integrating mechanistic remodeling pathways with measurable structural readouts (biopsy-derived indices and quantitative imaging) and emerging digital biomarkers derived from connected respiratory technologies. We propose an operational framework linking mechanism → biomarker → remodeling readout → timing decision, and we outline a 1-, 3-, and 5-year research roadmap in which advanced artificial intelligence (AI) methods (multimodal learning, causal inference, federated learning, and digital-twin architectures) evolve in parallel with wearable and smart-inhaler ecosystems. This landscape aims to standardize endpoints, sharpen trial design, and accelerate a shift from symptom control toward credible disease modification in severe asthma.

Allergy
University of Messina (IT), Humanitas University (IT), Istituto Ortopedico Gaetano Pini (IT), Universitätsmedizin Rostock (DE), IRCCS Humanitas Research Hospital (IT)
Openalex Percentile: Top 11%
Asthma and respiratory diseases
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