A critical look at the lexicon, parameters, and limitations of asthma remission definitions

How clinical remission in asthma is defined has important practical implications for both patients and clinicians. To move toward a single consensus definition of clinical remission in asthma, it is essential to understand the evolution of the concept of asthma remission and to evaluate critically the lexicon and criteria that comprise different remission definitions. While agreement appears strong on certain remission criteria (eg, lack of exacerbations and systemic corticosteroid therapy), the proposed definitions diverge on specific criteria for symptom control, lung function optimization, medication usage, and other measures of clinical improvement. Importantly, insufficient consideration has been given to biomarkers of type 2 inflammation as remission criteria, despite mounting evidence that elevated type 2 biomarker levels are associated with an increased risk for exacerbations and lung function decline. Factors such as body mass index, sex, and psychological comorbidities may affect the ability of some individuals to meet remission criteria. Patient perspectives and quality-of-life measures warrant deeper consideration if remission is to become a widely accepted and meaningful goal of asthma treatment. This article is part of a supplement supported by an educational grant from AstraZeneca Pharmaceuticals. The content of this article was developed independently by National Jewish Health and the article authors.