Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin, Madison, Wis.
Yale Center for Asthma and Airways Disease (YCAAD), Yale School of Medicine, New Haven, Conn.
J Allergy Clin Immunol Pract. 2024 Apr;12(4):894-903. doi: 10.1016/j.jaip.2024.01.044. Epub 2024 Feb 5.
The long-term goal of asthma management is to achieve disease control, comprising the assessment of 2 main domains: (1) symptom control and (2) future risk of adverse outcomes. Decades of progress in asthma management have correlated with increasingly ambitious disease control targets. Moreover, the introduction of precision medicines, such as biologics, has further expanded the limits of what can be achieved in terms of disease control. It is now believed that clinical remission, a term rarely associated with asthma, may be an achievable treatment goal. An expert framework published in 2020 took the first step toward developing a commonly accepted definition of clinical remission in asthma. However, there remains a widespread discussion about the clinical parameters and thresholds that should be included in a standardized definition of clinical remission. This review aims to discuss on-treatment clinical remission as an aspirational outcome in asthma management, drawing on experiences from other chronic diseases where remission has long been a goal. We also highlight the integral role of shared decision-making between patients and health care professionals and the need for a common understanding of the individual patient journey to remission as foundational elements in reducing disease burden and improving outcomes for patients with asthma.
哮喘管理的长期目标是实现疾病控制,包括评估 2 个主要领域:(1)症状控制和(2)未来不良结果的风险。哮喘管理的几十年进展与越来越雄心勃勃的疾病控制目标相关。此外,精准药物(如生物制剂)的引入进一步扩大了在疾病控制方面可以实现的目标范围。现在人们认为,临床缓解,一个很少与哮喘相关的术语,可能是一个可以实现的治疗目标。2020 年发布的一个专家框架朝着为哮喘制定普遍接受的临床缓解定义迈出了第一步。然而,关于应包括在临床缓解标准化定义中的临床参数和阈值,仍存在广泛的讨论。本综述旨在借鉴其他慢性病中缓解一直是目标的经验,讨论哮喘管理中的治疗缓解作为一个理想的结果。我们还强调了患者和医疗保健专业人员之间共同决策以及对个体缓解之旅的共同理解的重要作用,这些是减轻哮喘患者疾病负担和改善其结果的基础要素。