On Sept. 7, a new working definition for clinical remission on treatment in asthma was published in Annals of Allergy, Asthma & Immunology. The consensus paper is a product of the American College of Allergy, Asthma & Immunology (ACAAI), the American Academy of Allergy, Asthma & Immunology (AAAAI), and the American Thoracic Society (ATS). It is endorsed by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA).
As an increasing number of improved asthma treatments are developed, a greater number of people with asthma are finding that their symptoms are under control. Their improved status raises an important question for healthcare providers (HCPs) who treat this condition: “What qualifies as clinical remission in asthma treatment?”
The leadership of ACAAI convened a panel of 11 experts in asthma care in association with AAAAI and ATS to review available literature and create the definition of clinical remission on treatment in asthma. The panel included six allergists, three pulmonologists and two pediatricians.
The authors note that this document is a jumping-off point and a template to allow for further clinical research. They also commented that HCPs treating asthma patients can use this definition to generate needed data. The definition is expected to evolve over time.
As the term “remission” has historically implied total control of asthma, without medication use, the workgroup proposed six criteria for asthma clinical remission on treatment. Of the six criteria, three had unanimous consent, while the remaining three had factors that remain under consideration.
The following three criteria were unanimously agreed upon by members of the workgroup, who said they must be met over a 12-month period, and may be applied to those receiving monoclonal antibody therapy (biologic) for asthma:
- No exacerbations requiring a physician visit, emergency care, hospitalization, and/or systemic corticosteroid for asthma (i.e., oral, injectable).
- No missed work or school over a 12-month period due to asthma-related symptoms.
- Stable and optimized pulmonary function results on all occasions, when measured over a 12-month period, with a minimum of two measurements during the year.
The remaining three criteria (found in the manuscript) deal with frequency of use of certain therapies as well as measures of asthma symptoms such as assessment questionnaires and/or tools.
“While this is a research tool, it also provides an aspirational goal to attempt a more prolonged control,” says allergist John Oppenheimer, MD, a member of the workgroup and corresponding author of the paper. “This is achievable only in a subgroup of people with asthma, but reinforces the need to optimize and adhere to medications and sets a goal that will hopefully be the catalyst for further research and asthma medication development. It is important to note the document does not address complete remission off medication. It is meant to be a higher standard than control in the asthma patient.”
There is an accompanying editorial by Annals Editor-in-Chief Mitchell Grayson, MD.
The following physicians served as members of the expert panel and/or authors:
Michael Blaiss, MD
John J Oppenheimer, MD
Mark Corbett, MD
Len Bacharier, MD
Jonathan Bernstein, MD
Tara Carr, MD
Bradley Chipps, MD
Simon Couillard, MD, MSc
Erick Forno, MD, MPH
Torie Grant, MD, MHS
Njira Lugogo, MD
Kathleen May, MD
Eric Schauberger, DO, PhD