Asthma Remission - Is it a Holy Grail?

Abstract

The therapeutic goal for asthma is shifting from simple symptom control to the ambitious pursuit of remission, defined as a sustained period of comprehensive disease control. Historically, focusing solely on short-acting beta-agonists (SABA) led to poor outcomes, driving the adoption of combination therapies and, more recently, disease-modifying anti-asthmatic drugs (DMAADs). Remission is broadly categorized into clinical (absence of exacerbations and oral corticosteroid use, improved quality-of-life) and biological (normalization of inflammatory biomarkers). Adult remission is rare, underscoring the importance of identifying predictors (preserved lung function, shorter disease duration). Inspired by rheumatology, the focus on achieving low disease activity (LDA) aims to prevent irreversible lung damage. However, the concept's application is controversial, balancing the risk of overtreatment in milder cases against the need for intensive therapy in severe asthma. A consensus on remission criteria and the execution of prospective studies are imperative to distinguish active disease from established lung damage and solidify remission as an achievable clinical goal.