Glucocorticoids in the Management of Bronchial Asthma: From Pathophysiology to Precision Medicine

Bronchial asthma is a heterogeneous chronic inflammatory airway disease characterized by diverse pathogenic mechanisms and variable responses to therapy. This review article analyzes the essential role of glucocorticoids in asthma management, starting with the pathophysiological mechanisms involved in the progression of the disease and the characteristics of the Th2-high and Th2-low endotypes. The molecular and cellular mechanisms by which glucocorticoids regulate airway inflammation, reduce bronchial hyperresponsiveness, and improve clinical outcomes are discussed. Furthermore, the main forms of glucocorticoid administration—namely, inhaled, oral, and injectable formulations—are described, along with their integration into current recommended treatment strategies for the various severity levels of asthma. Particular attention is given to the phenomenon of glucocorticoid resistance, the factors involved in its development, and its impact on treatment efficacy. The article provides an analysis of the safety profile of glucocorticoid therapy, including adverse reactions, limitations on use, and the main contraindications. In conclusion, current trends and future prospects for optimizing the treatment of bronchial asthma are presented, with an emphasis on personalized glucocorticoid therapies and the identification of new therapeutic targets capable of improving disease control and patient outcomes.