Beyond the Inhaler: How Biologics, Phenotyping, and the Pursuit of Remission Are Redefining Airway Disease

Airway disease management is undergoing a structural transformation. For decades, asthma was treated as a single condition with a stepwise escalation of inhaled therapies, an approach that left the most severe cases cycling through treatments misaligned with their underlying biology. Updated global guidelines from the Global Initiative for Asthma (GINA) and ARIA-EAACI have shifted the field toward precision, biomarker-guided care. Central to this shift is the formal recognition of clinical remission as an achievable treatment goal, with real-world registry data now reporting on-treatment remission rates of 22%-34% across severe asthma populations on biologics. The united airway concept, linking allergic rhinitis, chronic rhinosinusitis, and asthma through shared T2 mechanisms, is reinforced by new evidence but remains fragmented in clinical practice. Meanwhile, environmental pressures including climate-driven allergen changes and air pollution are widening the gap between scientific capability and patient access, particularly in low- and middle-income settings. This article proposes the airway integration readiness (AIR) framework as a conceptual tool for evaluating how effectively care systems connect phenotype-guided therapy, cross-specialty airway co-management, and longitudinal remission tracking. It synthesizes the current evidence base, tracing how asthma and allergic airway disease are being redefined from episodic symptom management toward integrated, remission-oriented care, and identifies the translational challenges that remain.