Disease Modification in Severe Asthma-Are We There Yet?

We are in a time of great change and exciting possibilities in asthma assessment and management. Highly specific and effective targeted therapeutic options exist as well as clinically accessible and useful biomarkers. These developments have led to more ambitious treatment goals, such as disease remission. The availability of biomarkers that are both prognostic of adverse long-term outcomes and predictive of successful treatment to prevent or diminish these outcomes has increased interest in earlier targeted intervention. Early intervention may more successfully achieve disease modification; that is, stop disease in its tracks or even reverse pathologic changes before long-term irreversible damage is done. In this clinical commentary, we will consider an operational definition of disease modification, review evidence on disease modification in other well-established therapeutic areas, suggest longer-term adverse outcomes that should be prioritized for prevention, and review our current understanding of mechanisms contributing to and treatment responsiveness of these outcomes.