Asthma remission: what is it and how can it be achieved?

Abstract

Asthma treatment goals currently focus on symptom and exacerbation control rather than remission. Remission is not identical to cure but is a step closer. This review considers the current definitions of remission in asthma, the prevalence and predictors, the pathophysiology of remission, the possibility of achieving it using the available treatment options and the future research directions. Asthma remission is characterised by a high level of disease control, including the absence of symptoms and exacerbations, and normalisation or optimisation of lung function with or without ongoing treatment. Even in those who develop a symptomatic remission of asthma, persistent pathological abnormalities are common, leading to a risk of subsequent relapse at any time. Complete remission requires normalisation or stabilisation of any underlying pathology in addition to symptomatic remission. Remission is possible as part of the natural history of asthma, and the prevalence of remission in the adult asthma population varies between 2% and 52%. The factors associated with remission include mild asthma, better lung function, better asthma control, younger age, early-onset asthma, shorter duration of asthma, milder bronchial hyper-responsiveness, fewer comorbidities and smoking cessation or never smoking. Although previous studies have not targeted treatment-induced remission, there is some evidence to show that the current long-term add on therapies such as biologics and azithromycin can achieve some criteria for asthma remission on treatment, at least in a subgroup of patients. However, more research is required. Long-term remission could be included as a therapeutic goal in studies of asthma treatments.

Long-Term Efficacy and Clinical Remission After Benralizumab Treatment in Patients with Severe Eosinophilic Asthma: A Retrospective Study

“…As criteria for clinical remission, we used no exacerbations, no OCS use, well-controlled symptoms and stabilization of the %FEV 1 ; however, these criteria are not definitive and have some controversies. 13,14 A previous pooled post hoc analysis of benralizumab reported a CRR of approximately 15%, which is lower than that in the present study. One possible explanation for this difference is selection bias of participants.…”

“… 20 Clinical remission was defined according to the following criteria at the last follow-up period: no exacerbation requiring OCS treatment for 12 months, no maintenance OCS use, well-controlled asthma symptoms with an ACT score ≥ 20, and a %FEV 1 ≥ 80%. 13 , 14 Furthermore, we evaluated the yearly adherence to regular ICS/LABA treatment using the medication possession ratio (MPR). 21 We determined factors that affected clinical remission by evaluating BMI, MPR, disease duration, and comorbidities such as chronic rhinosinusitis with nasal polyp (CRSwNP)/eosinophilic chronic rhinosinusitis (ECRS), BEC, BBC, and FeNO at baseline.…”

“…In the switching group, the patients who received maintenance OCS continued mepolizumab treatment for 16.0 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) months and the rate of reduction in the maintenance OCS dose was −21.4% (Figure 1D). However, no further reduction in the maintenance OCS dose was observed in the switching group after switching to benralizumab.…”

“… 6 , 7 However, the long-term efficacy of benralizumab with respect to both exacerbation and pulmonary function decline over time remains unestablished, especially in real-world settings 11 , 12 Furthermore, clinical remission of severe asthma has recently been discussed as a therapeutic goal. 13 , 14 …”

“…6,7 However, the long-term efficacy of benralizumab with respect to both exacerbation and pulmonary function decline over time remains unestablished, especially in real-world settings 11,12 Furthermore, clinical remission of severe asthma has recently been discussed as a therapeutic goal. 13,14 We therefore conducted this single-center retrospective study to elucidate the long-term efficacy of benralizumab in a real-life setting. The primary endpoints were long-term pulmonary function measures, and the secondary endpoints were the clinical remission rate (CRR), the number of annual exacerbations, asthma symptoms, the maintenance OCS dose, and the relationships of these endpoints with patient characteristics.…”