Is clinical remission achievable in severe type 2 asthma?

Pneumology

Is clinical remission achievable in severe type 2 asthma?

Prof. Renaud Louis et Em. Prof . Guy Joos

Accrédité (25014775 - 1.5 points)

Asthma is a heterogeneous disease, and phenotypic characterisation can help to optimise therapeutic strategies, whether involving general anti-inflammatory interventions or specific targeted treatments. In patients who respond inadequately to conventional anti-inflammatory approaches, evaluating available biomarkers - such as blood eosinophils and exhaled nitric oxide fraction(FeNO) - is essential to guide management.

Once comorbidities have been managed and compliance has been ensured, patients with severe asthma may be candidates for biotherapies targeting type 2 inflammatory pathways (T2). However, the response to these biological agents varies among individuals, and further research is needed to identify selection criteria that can personalise treatment choices.

In the context of severe asthma, the concept of clinical remission has emerged, distinct from that of a super-responder.

Remission is defined by the absence of exacerbations, the discontinuation of oral corticosteroids, and sustained good symptom control over an extended period, or even preservation of respiratory function. To date, clinical remission has been observed in 30 to 40% of cases of severe asthma treated routinely with biological agents or azithromycin. A favourable response to biological treatment appears to be associated with elevated T2 biomarkers, low CRP levels, moderate changes in FEV1, and a shorter duration of disease progression. However, no clear predictive factors were identified for azithromycin.

The emerging concept of biological remission, as distinct from clinical remission, and its potential prognostic value, deserve further exploration.