Targeting remission in asthma
Aiming for a prized but neglected endpoint
In some people with asthma, one day, the disease goes into remission. We can’t predict to whom this happens yet. Nor how we might make it more likely. But we should pay a lot more attention to that outcome and start trying harder to reproduce it.
We now know there are different types of asthma and understand enough that we’ve started to personalize treatment. And the latest asthma medications align more closely than ever with the intermittent experience of many people with the disease. But the goals of asthma therapy remain focused on the lumbering concepts of management and control.
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We’ve stopped short of acknowledging that some people all but leave it behind. Yet a recent review of 14 studies suggests that asthma spontaneously remits in anywhere from 2 to 52 percent of people.1 How old the person was when asthma started, and how long it’s been around, appear important. As does what duration and degree of remission you’re talking about.
We can put it this way: Some level of remission is achievable in a subset of patients. We can’t say much more because we’ve not historically pursued remission as an endpoint, even as it has become a primary goal in many other diseases.
Recently, a workgroup of experts proposed a standard definition of remission in asthma, and encouraged we adopt it as a goal of treatment:
“Developing asthma remission as a treatment goal will provide a more ambitious target for novel therapies and treatment regimens and may enable a paradigm shift in the management of the disease.”2
It’s time to reset our vision in chronic respiratory disease and focus on remission as a guiding principle for asthma care, particularly for people with mild disease.
Now that we can build virtual-first clinics for specific purposes, it’s possible to design a practice and clinical protocols to safely pursue this new ambition. Not only might we create a better experience of asthma, built around promising new treatment options and a more compelling possible future for people with the disease, but in the process, we’ll finally learn more about what we’re getting right and wrong.
Thomas, Dennis, Vanessa M. McDonald, Ian D. Pavord, and Peter G. Gibson. 2022. “Asthma Remission: What Is It and How Can It Be Achieved?” The European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology 60 (5). https://doi.org/10.1183/13993003.02583-2021.
Menzies-Gow, Andrew, Mona Bafadhel, William W. Busse, Thomas B. Casale, Janwillem W. H. Kocks, Ian D. Pavord, Stanley J. Szefler, et al. 2020. “An Expert Consensus Framework for Asthma Remission as a Treatment Goal.” The Journal of Allergy and Clinical Immunology 145 (3): 757–65.