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.
Footnotes
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Conflict of interest: Dr. Thomas has nothing to disclose. Dr. McDonald reports grants and personal fees from GSK and AstraZeneca, and personal fees from Menarini, outside the submitted work. Dr. Pavord reports speaker's honoraria for sponsored meetings from AstraZeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis, Teva, Chiesi, Sanofi, Regeneron, and GSK; and payments for organising educational events from AstraZeneca, GSK, Sanofi, Regeneron, and Teva. He has received honoraria for attending advisory panels with Genentech, Sanofi, Regeneron, AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Teva, Merck, Circassia, Chiesi, Knopp, Almirall, Dey Pharma, Napp Pharmaceuticals, RespiVert, and Schering-Plough. He has received sponsorship to attend international scientific meetings from Boehringer Ingelheim, GSK, AstraZeneca, Teva, Sanofi, Regeneron, and Chiesi. He has received a grant from Chiesi to support a Phase II clinical trial in Oxford. He is co-patent holder of the rights to the Leicester Cough Questionnaire; and has received payments for its use in clinical trials from Merck, Bayer, and Insmed. Dr. Gibson reports grants and personal fees from GSK and AstraZeneca, personal fees from Novartis, Chiesi, and Sanofi, outside the submitted work.
*Content has been reproduced with permission from the Centre of Excellence in Treatable Traits, originally developed as part of the Centre of Excellence in Treatable Traits (https://treatabletraits.org.au)
Conflict of interest: Dr. Thomas has nothing to disclose.
Conflict of interest: Dr. McDonald reports grants and personal fees from GSK, grants and personal fees from AstraZeneca, personal fees from Menarini, outside the submitted work;.
Conflict of interest: Dr. Pavord reports other from Sanofi, other from Regeneron Pharmaceuticals, Inc., non-financial support from Excerpta Medica, during the conduct of the study; other from Aerocrine AB, other from Almirall, other from AstraZeneca, other from Boehringer Ingelheim, grants and other from Chiesi, other from GSK, other from Novartis, other from Regeneron Pharmaceuticals, Inc, other from Sanofi, other from Teva, other from Circassia, other from Dey Pharma, other from Genentech, other from Knopp Biosciences, other from Merck, other from MSD, other from Napp Pharmaceuticals, other from RespiVert, other from Schering-Plough, outside the submitted work.
Conflict of interest: Dr. Gibson reports grants and personal fees from GSK, grants and personal fees from AstraZeneca, personal fees from Novartis, personal fees from Chiesi, personal fees from Sanofi, outside the submitted work;.
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- Received September 28, 2021.
- Accepted March 17, 2022.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
