## 3 Results
### Cellular Diagnostic Parameters and Biomarkers in Asthma
#### 3.1.2 Asthma Treatment  
Due to asthma heterogeneity, symptoms, and severity, the goal of asthma treatment is to ameliorate this pathology's symptoms, avoiding future risks. Historically, asthma has been treated with anti-inflammatory drugs and bronchodilators [95]. The reliever treatment with inhaled corticosteroids (ICs)-formoterol reduces the risk of exacerbations as compared to the use of SABA. However, nowadays, new techniques have been developed, comprising immunotherapy and biologics [95; 96] (Figure 3). In most cases, personalized asthma treatment is necessary, because each patient develops symptoms in a different way [97]. Therefore, there are two critical factors in the treatment of asthma: the patient's symptoms and the way that the patient reacts to medication [98]. Currently, two categories of drugs are used for the treatment of asthma: rescue and controller drugs [15] (Figure 3). Rescue drugs are used to alleviate symptoms quickly (within minutes), whereas controller medicines are used daily to treat all asthma symptoms and to achieve asthma remission [99; 15]. The main rescue drugs are inhaled, rapid-acting \(\beta 2\) adrenergic agonists (SABAs), such as albuterol and levalbuterol [100]. They are recommended for patients with mild or intermittent asthma [15]. SABAs bind to \(\beta\)-adrenergic receptors from the smooth muscle cells of the lung, causing the release of Ca2+ and, subsequently, muscle relaxation, mitigating asthma symptoms in a few minutes [101]. The use of these medicines is still limited because of their adverse effects: tremors, tachycardia, and hypocalcemia [100]. Figure 3: Therapeutic tools in asthma and AR. Traditionally, asthma and AR have been treated with classical drugs, such as bronchodilators, antihistamines, and corticosteroids. The form of administration of glucocorticoids is inhaled in asthmatic patients, while in patients with AR it is intranasal. However, in the last decades, the development of novel and more specific therapeutic tools such as biologists and immunotherapy have permitted a more personalized medicine for asthma and AR. Severe asthma is defined as uncontrolled asthma despite optimized treatment with high-dose of ICs and long-acting \(\beta\)2 adrenergic agonists (LABAs), or requires this treatment to prevent exacerbations [15]. So, ICs are the first option as controller drugs, such as montensone, budesonide, and ciclesonide [100]. These medications act as anti-inflammatory molecules, producing a long-term reduction in asthma symptoms [100,102]. However, ICs have negative side effects such as oral infections, hoarseness, reduction in growth velocity, osteoporosis, or hypothalamic-pituitary-adrenal axis suppression [103]. In addition to ICs, oral corticosteroids (OC) can be also used in asthma management [15]. They have more anti-inflammatory power than ICs, but also more adverse effects (loss of bone density, hyperglycemia, weight gain, cataracts, hypothalamic-pituitary-adrenal axis suppression, diabetes, sleep apnea, etc.) [104,105]. Nevertheless, an optimal concentration of OCs can be helpful in relieving symptoms of moderate-severe asthma [100]. Another type of drug employed in asthma control treatment is an LABA, such as salmeterol, formoterol, and vilanterol, having a similar mechanism of action to SABAs, blocking \(\beta\)-adrenergic receptors on the smooth muscle of the lung, and relaxing smooth muscle [100]. Although LABAs have a longer half-life than SABAs, they are considered controller drugs. LABAs are recommended to be used in combination with other corticosteroids [15]. On the other hand, other drugs used in the treatment of asthma are antileukotrienes, such as montelukast and zafirlukast. Leukotrienes are inflammatory molecules produced during the Th2 response by the degranulation of basophils, mast cells, and eosinophils. These molecules are responsible for airway inflammation and subsequent asthma symptoms [106,107].