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    Objectives: To test if urinary eicosanoid metabolites can direct asthma phenotyping. Validation was performed internally in participants with SA followed up after months and externally in 95 adolescents with asthma.

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    Measurement and Main Results: Metabolite concentrations in healthy control participants were unrelated to age, body mass index, and sex, except for the PGE2 pathway. Eicosanoid concentrations were generally greater in participants with MMA relative to healthy control participants, with further elevations in participants with SA.

    However, PGE2 metabolite concentrations were either the same or lower in male nonsmokers with asthma than in healthy control participants.

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    Metabolite concentrations were unchanged in those with asthma who adhered to oral corticosteroid treatment as documented by urinary prednisolone detection, whereas those with SA treated with omalizumab had lower concentrations of LTE4 and the PGD2 metabolite 2,3-dinorß-PGF2α. These type 2 T2 asthma associations were reproduced in the follow-up visit of the U-BIOPRED study and were found to be as sensitive to detect T2 inflammation as the established biomarkers.

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    Conclusions: Monitoring of urinary eicosanoids can identify T2 asthma and introduces a new noninvasive approach for molecular phenotyping of adult and adolescent asthma. Clinical trial registered with www.

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