Obstructive Airways DiseaseSevere Asthma: The Evolution of Patient-directed ManagementKeller, Michael MD; Kamp, David MDAuthor Information Department of Medicine, Division of Pulmonary & Critical Care Medicine, Jesse Brown VA Medical Center and Northwestern University Feinberg School of Medicine, Chicago, IL Disclosure: The authors declare that they have no conflicts of interest. Address correspondence to: Michael Keller, MD, Department of Medicine, Division of Pulmonary & Critical Care Medicine, Northwestern University Feinberg School of Medicine, 240 E. Huron, McGaw M-330, Chicago, IL 60611. E-mail: firstname.lastname@example.org. Clinical Pulmonary Medicine: January 2014 - Volume 21 - Issue 1 - p 1-8 doi: 10.1097/CPM.0000000000000013 Buy Metrics Abstract Severe asthma has been increasingly recognized as a heterogenous disease with varied clinical characteristics and pathophysiological processes. Patients with severe asthma suffer significant impairment in their daily life and impose a substantial burden on health care resources. The recent work of consortia groups has led to an improved definition of severe asthma as well as better characterization of the patients with severe disease. Different approaches, including unbiased cluster analyses, have been utilized to identify severe asthma phenotypes (subgroups) defined by their clinical characteristics and immune processes. Recognition of severe asthma phenotypes has assisted the development of targeted therapies by identifying patients more likely to respond to the specific agent. In this article, we discuss the evolution of our understanding of severe asthma and review the currently available therapies and promising drugs in development. In addition, we examine the role of bronchoscopy in severe asthma and the emerging evidence regarding bronchial thermoplasty. © 2014 by Lippincott Williams & Wilkins, Inc.