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.

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

Natural Disease Course

Therapeutic Intervention

*Disease remission is broadly defined as a state or period with low to no disease activity and can be spontaneous or a result of therapy 1
†Disease modification is an evolving topic in asthma and further study is required to demonstrate whether current interventions have the potential to modify disease.

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.

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

Asthma Control15,16*

Zero exacerbations requiring
hospitalization in previous 12 months

On-Treatment Clinical Remission1-7

For ≥12 Months

Zero exacerbations

*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.

ACHIEVING LUNG FUNCTION STABILIZATION
OR IMPROVEMENT IS A KEY
COMPONENT OF ASTHMA REMISSION1-7

Asthma Control15,16*

FEV1pp ≥80%

On-Treatment Clinical Remission1-7

For ≥12 Months

Stable or optimized lung function

*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.

ZERO OCS USE IS REQUIRED FOR A STATE
OF ASTHMA REMISSION1-7

Asthma Control15,16*

<2 exacerbations requiring OCS
in previous 12 months

On-Treatment Clinical Remission1-7

For ≥12 Months

Zero exacerbations requiring OCS

*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.

LONG-TERM SYMPTOM CONTROL IS
AN IMPORTANT PATIENT-REPORTED
COMPONENT OF ASTHMA REMISSION1-7

Asthma Control15,16*

ACQ ≤1.5 or ACT ≥20

On-Treatment Clinical Remission1-7

For ≥12 Months

ACQ ≤1.5 or ≤0.75; or ACT ≥20

*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.

  1. Lommatzsch M, et al. S2k-Leitlinie zur fachärztlichen Diagnostik
    und Therapie von Asthma 2023 [S2k guidelines for specialist
    diagnostics and treatment of asthma 2023]. Published by the
    German Respiratory Society (DGP) 6 March 2023. Accessed
    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
  3. Canonica GW, et al. J Allergy Clin Immunol Pract. 2023;11(12);
    3629-3637.
  4. Japan Asthma Society (JAS). Practical Guidelines for Asthma
    Management (PGAM). Updated July 2023. Accessed 11 November,
    2023. https://jasweb.or.jp/guideline.html
  5. Blaiss M, et al. Ann Allergy Asthma Immunol. 2023;131(6):782-785.
  6. Menzies-Gow A, et al. J Allergy Clin Immunol. 2020;145(3):757-765.
  7. Thomas D, et al. Eur Respir J. 2022;60(5):2102583.
  8. Bieber T. Nat Rev Drug Discov. 2023;22(8):662-680.
  9. Busse WW, et al. Eur Respir Rev. 2022;31(163):210183.
  10. Lommatzsch M, et al. Lancet. 2022;399(10335):1664-1668.
  11. Barach AL. J Am Med Assoc. 1951;147(8):730-737.
  12. Sullivan TJ. Pediatr Clin North Am. 1992;39(6):1363-1382.
  13. Upham JW, James AL. Pharmacol Ther. 2011;130(1):38-45.
  14. Crompton G. Prim Care Respir J. 2006;15(6):326-331.
  15. Global Initiative for Asthma (GINA). Global strategy for asthma
    management and prevention. Updated May 2023. Accessed 2 May
    2023. https://ginasthma.org/ gina-reports/.
  16. Chung KF, et al. Eur Respir J. 2014;43(2):343-373.
  17. Matsunaga K, et al. J Allergy Clin Immunol Pract. 2015;3(5):759-764.
  18. Sullivan PW, et al. J Allergy Clin Immunol. 2018;141(1):110-116.e7.
  19. Bleecker ER, et al. Am J Respir Crit Care Med. 2020;201(3):276-293.
  20. Waljee AK, et al. BMJ. 2017;357:j1415.
  21. Khan AH, et al. J Asthma Allergy. 2022;15:1639-1644.
  22. Ali Z, et al. Chest. 2013;143(6):1649-1655.
  23. Kawamatawong T, et al. Asian Pac J Allergy Immunol. 2022;40(1):1-21.
  24. Barnes PJ, et al. Allergy. 2014;69(9):1119-1140.
  25. Juniper EF, et al. Respir Med. 2006;100(4):616-621.
  26. Schatz M, et al. J Allergy Clin Immunol. 2006;117(3):549-556.
  27. Schatz M, et al. J Allergy Clin Immunol. 2009;124(4):719-23.e1.