ON-TREATMENT ASTHMA REMISSION: MOVING BEYOND CONTROL
Proposed Framework for Remission1-7
Remission: A state or period with low to no disease activity that can be spontaneous or as a result of therapy6
Several Countries Have Recommended Clinical Remission Definitions1-5
*A broad consensus definition is being developed with over 120 experts and is expected in the GEMA 5.4 update.
†The US workgroup determined that symptom and lung function criteria must be met on all occasions measured in the previous 12-month period with a minimum of two measurements during the year.
The definition of on-treatment remission in asthma has not yet been established and further consensus among experts, guidelines, and societies is warranted.6
This tool showcases the evolving evidence around asthma remission as of February 2024 and is intended for educational purposes only.
ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; AirQ, Asthma Impairment and Risk Questionnaire; FEV1, forced expiratory volume in 1 second; ICS, inhaled corticosteroids; OCS, oral corticosteroids.
EVOLUTION OF ON-TREATMENT REMISSION IN ASTHMA
How Can Therapeutic Intervention Get Us to On-Treatment Clinical Remission?6-10
Over 70-Years of On-Treatment Clinical Remission in Asthma
Remission may be achieved on or off treatment. Different definitions of remission have been proposed and implemented in various studies. Given this evolving framework for remission, further studies may provide a pathway to inform our understanding of disease modification in severe asthma.6
This tool showcases the evolving evidence around asthma remission as of February 2024 and is intended for educational purposes only.
ICS, inhaled corticosteroids; LABA, long-acting beta agonist; SABA, short-acting beta agonist; SCS, systemic corticosteroids.
REDUCING EXACERBATIONS IS A FUNDAMENTAL CRITERION OF ASTHMA REMISSION1-7
*Adapted from GINA and ERS/ATS. †Severe exacerbation was defined as worsening asthma requiring at least 3 days of treatment with systemic corticosteroids, or a hospitalization due to asthma. ATS, American Thoracic Society; BD, bronchodilator; ERS, European Respiratory Society; FEV1, forced expiratory volume in 1 second; GINA, Global Initiative for Asthma.
ZERO OCS USE IS REQUIRED FOR A STATE OF ASTHMA REMISSION1-7
*Adapted from GINA and ERS/ATS. †P<0.001.20
AE, adverse event; ATS, American Thoracic Society; ERS, European Respiratory Society; GI, gastrointestinal; GINA, Global Initiative for Asthma; OCS, oral corticosteroids.
ACHIEVING LUNG FUNCTION STABILIZATION OR IMPROVEMENT IS A KEY COMPONENT OF ASTHMA REMISSION1-7
*Adapted from GINA and ERS/ATS. †n=1865; Cox proportional hazard model analysis adjusted for age at index date, smoking status, body mass index, gender, rhinitis, chronic sinusitis, nasal polyps, atopic dermatitis, diabetes, anaphylaxis, ischemic heart disease, heart failure, food allergy, anxiety, depression, and psoriasis.8 ‡n=1075; relative risk of death from asthma during 25 years of follow-up.9 ATS, American Thoracic Society; BD, bronchodilator; CI, confidence interval; ERS, European Respiratory Society; FEV1, forced expiratory volume in 1 second; FEV1pp, FEV1 percent predicted; GINA, Global Initiative for Asthma; HR, hazard ratio.
LONG-TERM SYMPTOM CONTROL IS AN IMPORTANT PATIENT-REPORTED COMPONENT OF
ASTHMA REMISSION1-7
*Adapted from GINA and ERS/ATS.
ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; ATS, American Thoracic Society; BD, bronchodilator; ERS, European Respiratory Society; FEV1, forced expiratory flow in 1 second; GINA, Global Initiative for Asthma.
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11 November 2023. https://register.awmf.org/assets/
guidelines/020-009l_S2k_Fachaerztliche-Diagnostik-Therapie-von-Asthma_2023-03.pdf
2. GEMA 5.3: Guía Española para el manejo del asma [GEMA 5.3: Spanish asthma management guidelines]. Accessed 11 November 2023. https://www.separ.es/node/1827
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