Moving towards asthma remission from mechanistic understanding to clinical practice

In the past, treatment of asthma aimed primarily at "control" of symptoms and a reduction of future risk. Recently, however, the concept of remission has been introduced which is broader than control and includes the concept of disease modification by using disease-modifying antiasthmatic drugs (DMAADs) that exclude the use of systemic corticosteroids. This review highlights the definitions as well as the clinical implications of the concept of remission in asthma.

While in the past remission has been used mainly for the relatively rare event of spontaneous cessation of symptoms of asthma, a new definition has been proposed and included in several national guidelines and most recently also in international guidelines which include absence of symptoms, no exacerbations, stable pulmonary function, no need for systemic corticosteroids. In this review, novel definitions and their clinical implications are being discussed such as remission off treatment (e.g. following allergen immunotherapy) and remission on treatment (e.g. during treatment with a biologic). Furthermore, the concept of partial remission as well as the need to further investigate the interdependence of clinical and biological remission (reduction or normalization of inflammatory biomarkers) is discussed. This concept includes for the majority of patients the continuous use of a personalized treatment with DMAADs with a potentially lower treatment burden, provided patients are properly phenotyped and comorbidities are being recognized and treated.

In contrast to previous guidelines, applying the concept of remission has the potential to improve asthma care with earlier interventions with DMAADs and broader treatment approaches to improve long-term outcomes.