Achieving remission in severe asthma

Abstract

Severe asthma affects 5–10 % of asthma patients worldwide, imposing a significant burden due to an increased risk of mortality, impaired quality of life, and substantial economic costs. Recent advancements in biologic therapies have transformed asthma management by targeting specific inflammatory pathways, particularly type 2 inflammation. Biologic treatments such as omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab have demonstrated efficacy in reducing exacerbations, improving lung function, and achieving clinical remission in a subset of patients. This review provides an overview of the mechanisms of action, indications, and treatment efficacy of biologics used in asthma management. We also explore the concept of asthma remission and the potential for achieving it through biologic therapies and complementary strategies, including optimized inhaler use, macrolides, and bronchial thermoplasty. In addition, we discuss how to choose among these treatments wisely and examine the limitations of each biologic therapy. Despite these advancements, clinical remission rates remain modest, underscoring the need for refined patient selection. Emerging tools such as airway biomarkers, proteomics, and advanced imaging techniques offer promising avenues to improve diagnosis and personalize treatment approaches. Future research focused on making advanced biomarkers more accessible and feasible for point-of-care testing will enhance treatment precision. The next step will be integrating a multiomics approach into personalized asthma management for severe disease, further improving asthma control, achieving sustained remission, and ultimately reducing the burden of severe asthma.