• Steven E Lommatzsch, Richard J Martin, and James T Good.
• Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, National Jewish Health, University of Colorado Denver, Denver, Colorado 80206, USA.
• Curr Opin Pulm Med. 2013 Jan 1;19(1):42-8.

Purpose Of ReviewThis review summarizes the phenotyping of refractory asthma with an emphasis on how direct bronchoscopic observation and analysis of bronchoalveolar lavage (BAL), biopsy, and brushings of the airways helps direct specific personalized therapy. Additional testing used in phenotyping asthmatic patients is reviewed.Recent FindingsSeveral studies and publications over the past decade have emphasized the importance of phenotyping refractory asthmatic patients to offer a better understanding of the pathobiology of disease. Bronchoscopy is a useful tool in phenotyping asthma with objective data obtained from BAL, endobronchial biopsy, and brushings. Phenotyping asthma with bronchoscopy affords personalized and successful therapy.SummaryBy using fiberoptic bronchoscopy, specific asthma phenotypes can be identified: laryngopharyngeal reflux with silent aspiration; subacute bacterial infection; tissue eosinophilia; a combination of two or three of these; and nonspecific. Identifying these phenotypes and personalizing therapy with bronchoscopy leads to improved outcomes.

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