ADULT ASTHMA: EPIDEMIOLOGY, PATHOPHYSIOLOGY, SEASONALITY, SOCIOECONOMIC IMPACT, DIAGNOSIS, COMORBIDITIES, AND THERAPEUTIC ADVANCES – A SCOPING REVIEW (PRISMA-SCR)

Abstract

Background: Adult asthma is a chronic inflammatory airway disease and remains a major driver of exacerbations and healthcare use.

Objective: To map and critically synthesize contemporary evidence (2015–2025) on adult asthma pathophysiology, objective diagnostic confirmation, classification, stepwise pharmacologic management, and advanced therapies, with emphasis on the Brazilian context.

Methods: Scoping review following PRISMA-ScR. We searched PubMed/MEDLINE, SciELO and LILACS, and screened key guidelines (GINA and SBPT/JBP). We included studies in adults (≥18 years), systematic reviews, clinical trials, consensus statements and policy documents. Screening and full-text assessment were followed by data charting across thematic domains.

Results: Evidence supports the heterogeneity of adult asthma, with type 2 inflammation predominant in many patients and increasing recognition of non–type 2 phenotypes (e.g., obesity-, smoking- and occupational exposure–associated). Objective functional confirmation is essential yet underused. Current recommendations discourage SABA-only treatment and prioritize inhaled corticosteroids (ICS) from early steps; ICS–formoterol maintenance-and-reliever therapy (MART/SMART) reduces exacerbations. In severe asthma, phenotyping, biomarkers, and biologics (anti-IgE, anti-IL-5/5R, anti-IL-4/13 and anti-TSLP) improve outcomes in selected subgroups. Gaps remain in access to spirometry, education, adherence, and equitable incorporation of advanced therapies in Brazil.

Conclusion: Adult asthma management requires objective diagnosis, early anti- inflammatory therapy, and risk- and phenotype-guided personalization, alongside system- level strategies to reduce care inequities.