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workup of asthma. However, there are a number of limitations in our study. First, we did not have access to
lower lung samples, such as sputum or bronchoalveolar lavage fluid. Ideally these sources of sample would
be most accurate for determining the presence of eosinophilic airway inflammation. Second, this is a cross-
sectional study. Future work will be needed to determine whether these phenotypes change over time. In
addition, prospective studies will need to be done to determine whether categorizing asthmatics into these
clusters has predictive value, specifically to determine whether these specific groups have different clinical
outcomes and different response to asthma medications. As a number of specific medications targeting
eosinophils, IgE, and specific cytokines are now available (and many more in development), miRNA expression
profiles may have a useful role in helping to select the specific therapy for the specific subtype of asthma.

DECLARATIONS
Authors’ contributions
Conception, design of the study, data analysis and interpretation: Zhang S, Laryea Z, Panganiban R,
Lambert K, Ishmael FT
Data acquisition, provided administrative, technical, and material support: Hsu D

Availability of data and materials
Data and materials are available to readers and can be obtained by contacting the corresponding author.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
This study was approved by the Penn State Institutional Review Board in accordance with the Declaration of
Helsinki. All subjects agreed to participate in the study and provided written informed consent.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

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