Researchers Reframe the Definition of Clinical Remission for Asthma

As asthma treatments and therapies continue to develop, researchers are redefining a standard and accepted understanding of remission in asthma. Published in the Annals of Allergy, Asthma, and Immunology, the researchers aimed to create a mutual agreeable definition of asthma remission or clinical remission on treatment.

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The researchers noted that current treatments like inhaled corticosteroids (ICS) and long-acting bronchodilator (LABA) therapy have aided the control of asthma. In a definition from the National Cancer Institute, experts define cancer remission in different categories focused on a decrease of symptoms, although cancer could still be present within the body. The researchers used this definition in terms of remission for asthma, as treatment does not need to be stopped to reach the point of remission.

Medical organizations have expressed the need for treatment and therapy experts to properly define the terms of asthma remission. A workgroup of 11 asthma experts from a pulmonary society and a pediatric society was formed by the American College of Allergy, Asthma, and Immunology; the American Academy of Allergy, Asthma, and Immunology; and the American Thoracic Society to outline clinical remission on asthma treatment. The workgroup included 6 allergists, 3 pulmonologists, and 2 pediatricians.

Current proposed asthma remission definitions contrast with each other regarding the criteria that deems an individual to be in remission. The criteria from these definitions were through a modified Delphi approach, conducted using a survey, according to the researchers.

“While the attainment of a state of remission in asthma is laudable, the workgroup consensus is that this should be a high bar to achieve, as the term ‘remission’ here has historically denoted total control of asthma, absent any medication use. With that being stated, the workgroup proposes 6 components for ‘asthma clinical remission on treatment,’” said the study authors.

The study noted that the workgroup added criteria of minimal rescue albuterol into their definition that was not previously used by other authors. The workgroup then developed 6 criteria that must be met for longer than a 12-month period to be deemed as in remission.

The criteria included:

1. No worsening in symptoms that would necessitate help from a health care provider or systemic corticosteroid use
2. No absence or missed assignments from work or school due to asthma-related symptoms
3. When measured over a 12-month period with 2 measurements per year, a stable and improved pulmonary function must be reported.
4. Low or medium continued dose of controller therapies (ICS< ICS/LABA).
5. An ACT >20, AirQ <2, ACQ<0.75 reported when measured in the 12-month period, with a minimum of 2 measurements within the year
6. Once monthly use of reliever therapy (SABA, ICS-SABA, ICS-LABA) for symptoms that will not subside.

The conclusions reached by the workgroup could be similar to what other experts would develop, but this is unknown. However, the researchers said these conclusions will be a starting point to aid a change in the true definition of asthma remission.

Reference

Consensus of an ACAAI, AAAAI, and ATS Workgroup on Definition of Clinical Remission in Asthma on Treatment. Science Direct. News release. September 8, 2023. Accessed September 28, 2023. https://www.sciencedirect.com/science/article/pii/S1081120623012188.