An expert consensus framework for asthma remission as a treatment goal

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:145

Review

Menzies-Gow, Andrew¹  Bafadhel, Mona^2,3  Busse, William W.⁴  Casale, Thomas B.⁵  Kocks, Janwillem W. H.^6,7,8  Pavord, Ian D.²  Szefler, Stanley J.^9,10  Woodruff, Prescott G.^11,12  de Giorgio-Miller, Alexander¹³  Trudo, Frank¹⁴  Fageras, Malin¹⁵  Ambrose, Christopher S.¹⁶ 

[1] Royal Brompton Hosp, Resp Med, London, England

[2] Univ Oxford, John Radcliffe Hosp, Nuffield Dept Med, Resp Med Unit, Oxford, England

[3] Univ Oxford, John Radcliffe Hosp, Nuffield Dept Med, Oxford Biomed Res Ctr, Oxford, England

[4] Univ Wisconsin, Dept Med Allergy Pulm & Crit Care Med, Madison, WI USA

[5] Univ S Florida, Morsani Coll Med, Div Allergy & Immunol, Dept Internal Med, Tampa, FL 33620 USA

[6] Gen Practitioners Res Inst, Groningen, Netherlands

[7] Observat & Pragmat Res Inst, Singapore, Singapore

[8] Univ Med Ctr Groningen, Groningen Res Inst Asthma & COPD GRIAC, Groningen, Netherlands

[9] Univ Colorado, Sch Med, Childrens Hosp Colorado, Breathing Inst, Aurora, CO USA

[10] Univ Colorado, Sch Med, Dept Pediat, Aurora, CO USA

[11] UCSF, Div Pulm & Crit Care Med, Dept Med, San Francisco, CA USA

[12] CVRI, San Francisco, CA USA

[13] AstraZeneca, Cambridge, England

[14] AstraZeneca, Wilmington, DE USA

[15] AstraZeneca, Gothenburg, Sweden

[16] AstraZeneca, Gaithersburg, MD USA

关键词: Asthma;    remission;    treatment;    consensus;    lung;    biomarkers;    inflammation;    surveys and questionnaires;    exacerbation;    hyperresponsiveness;    airway remodeling;   

DOI  :  10.1016/j.jaci.2019.12.006

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

Free