An Expert Consensus Framework for Asthma Remission as a Treatment Goal

Andrew Menzies-Gow, Mona Bafadhel, William W Busse, Thomas B Casale, Janwillem W H Kocks, Ian D Pavord, Stanley J Szefler, Prescott G Woodruff, Alexander de Giorgio-Miller, Frank Trudo, Malin Fageras, Christopher S Ambrose

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Abstract

With novel therapies in development, there is an opportunity to consider asthma remission as a treatment goal. In this Rostrum, we present a generalized framework for clinical and complete remission in asthma, on and off treatment, developed on the basis of medical literature and expert consensus. A modified Delphi survey approach was used to ascertain expert consensus on core components of asthma remission as a treatment target. Phase 1 identified other chronic inflammatory diseases with remission definitions. Phase 2 evaluated components of those definitions as well as published definitions of spontaneous asthma remission. Phase 3 evaluated a remission framework created using consensus findings. Clinical remission comprised 12 or more months with (1) absence of significant symptoms by validated instrument, (2) lung function optimization/stabilization, (3) patient/provider agreement regarding remission, and (4) no use of systemic corticosteroids. Complete remission was defined as clinical remission plus objective resolution of asthma-related inflammation and, if appropriate, negative bronchial hyperresponsiveness. Remission off treatment required no asthma treatment for 12 or more months. The proposed framework is a first step toward developing asthma remission as a treatment target and should be refined through future research, patient input, and clinical study.

Original languageEnglish
Pages (from-to)757-765
Number of pages5
JournalJournal of Allergy and Clinical Immunology
Volume145
Issue number3
Early online date19-Dec-2019
DOIs
Publication statusPublished - Mar-2020

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