Severe asthma presents a significant clinical challenge, marked by heightened exacerbation risk, diminished lung function, fixed airflow obstruction, and substantial morbidity and mortality. As new therapies increasingly target specific inflammation pathways, the notion of achieving remission in severe asthma has garnered attention as a treatment goal.
In a review published in Respiratory Research, coauthors Ines Farinha and Liam G. Heaney explored current definitions for remission and identified barriers to attaining remission among patients with severe asthma.
“The definition of remission in asthma should be both comprehensive and practical, and it should address multiple impacts of the disease across the whole spectrum of severity, in order to improve the existing concept of asthma control,” Farinha and Heaney wrote. “It should be based on daily asthma symptoms, exacerbation frequency, future exacerbation risk, pulmonary function and laboratory markers of inflammation, and it should require an adequate duration of assessment to address variability (including seasonality) of disease activity.”
While a unified definition remains elusive, clinical remission in asthma typically entails sustained symptom control, cessation of exacerbations, and lung function stabilization. However, achieving these criteria proves realistic for only a minority of patients, according to the review authors.
“Some unmet needs in severe asthma may affect the achievement of clinical remission,” the authors wrote. “Airway infection is an important component in persistent exacerbations in patients on biologic therapies. Another challenge associated with the aim of clinical remission in severe asthma is the multifaceted interaction between the disease and its associated comorbidities.”
Phenotyping exacerbations can aid therapy decision-making. Evaluating behavioral factors alongside optimized treatment and leveraging biomarkers to target treatable traits may offer a more objective approach to remission.
“Airway structural changes, such as fixed airway obstruction, the presence of bronchiectasis, and mucus hypersecretion may also challenge the achievement of remission in severe asthma. Different inflammatory pathways related to asthma require precision medicine approaches like ‘treat-to-target’ to increase the likelihood of success in reaching remission,” the authors wrote.
The reviewers recommended an international consensus to define the concept of clinical re – mission in severe asthma and create guidelines for its assessment.
