Defining minimal clinical disease activity and remission in severe asthma: a modified Delphi consensus

The introduction of biologics in the treatment of severe asthma, has led to improved patient outcomes and increased discussions around remission. Due to varying descriptions of remission, there is a clear need for a standardised definition of remission as a target for patients. Remission has stringent criteria to achieve the best possible outcomes for patients; however not all patients achieve remission dependent on their disease severity and duration. Therefore, less stringent criteria should also be considered such as a patient state of minimal clinical disease activity (MCDA). To explore these definitions, a Steering Committee of respiratory healthcare professionals (HCPs) employed a systematic literature review (SLR) and modified Delphi consensus. Outputs of the SLR were used to draft consensus statements that underwent two rounds of review with the Steering Committee and one round of review with a wider group of HCPs. Initial definitions of MCDA and remission were drafted based on the consensus statements and finalised in a Steering Committee meeting. The definitions include criteria for asthma exacerbations, steroid use, lung function, and quality of life. These definitions serve as a starting point for improving disease management in patients with severe asthma and should be validated in real-world settings.