Asthma Remission

Asthma remission is a relatively new concept. Traditionally, asthma management has focussed on symptom control and reducing exacerbations. However, the emergence of targeted pharmacologic and immunotherapeutic treatments has prompted a shift in this approach. A new paradigm of disease management in asthma now considers asthma remission a realistic and achievable goal— as seen in other inflammatory diseases such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis (Thomas et al. 2022 & Chiewchalermsri et al. 2025).

Thomas et al refers to asthma remission as a high level of disease control, including the absence of symptoms and exacerbations, and normalisation or optimisation of lung function with or without ongoing treatment – usually for ≥12 months (Thomas et al. 2022). Factors that can contribute to asthma remission include the use of biologics (highly effective in eosinophilic asthma), maintenance macrolides, and using a treatable traits approach to improve asthma outcomes.

Asthma remission is not a cure, and subsequent relapse is possible at any time (Thomas et al. 2022). Menzies-Gow et al, categorises asthma remission into two distinct groups – clinical remission and complete remission, in which both can be further divided into remission on treatment and off treatment (Thomas et al. 2022). Early intervention is important to achieve asthma remission, whereby treatment can stop the disease in its track or even reverse pathologic changes before long term irreversible damage is done.

• Clinical remission: is classified by an absence of symptoms, no exacerbations/attacks and optimised lung functions
• Complete remission: requires normalisation or stabilisation of any underlying pathology in addition to symptomatic remission

The prevalence of remission in the adult asthma population varies between 2% and 52% (Thomas, et al. 2022). This wide range in asthma remission rates can be largely attributed to the varying definitions of asthma remission (clinical vs complete remission) and asthma remission historically not being a realistic target in asthma research and management. In severe asthma, however, remission can be achieved in as many as 30% of people using biologics (Shackleford et al. 2024), or 50% with azithromycin (Thomas, 2024). A systematic review on clinical remission was undertaken and found that the pooled rate of remission was 30-38% in people with severe asthma treated with biologics, depending on definition used (Shackleford et al. 2024). Lower clinical remission rates were associated with several pulmonary factors, including reduced FEV₁, more severe asthma symptoms, longer disease duration, and use of maintenance oral corticosteroids. Non-pulmonary factors, particularly comorbidities such as depression and obesity, also posed significant barriers to achieving clinical remission (Couillard et al, 2025). Several studies have identified predictors of asthma remission. These include:

An increasing array of asthma therapies are recognised to lead to asthma remission. Monoclonal Therapies (Biologics) have been highly effective in treating eosinophilic (Type-2 inflammation) asthma, when combined with a treatable traits approach, it can contribute to remission outcomes in a subset of the severe asthma population (Shackleford et al. 2024). Biologics act on the effector molecules of the T2 inflammatory cascade and are highly effective in reducing exacerbations and symptoms, and in improving lung function (Thomas, et al. 2022). See Medications section for more information on monoclonal therapies.

Identifying and treating underlying behavioural and biological treatable risk factors, to minimise their effects on asthma. These include comorbidities such as vocal cord dysfunction, smoking, obesity. Given that the factors preventing remission are beyond pulmonary inflammation the concept of treatable traits as a pathway to remission has been proposed (Thomas et al. 2025, Farinha et al. 2025 & Gibson et al. 2024). See Treatable Traits, for more information.

Using the treatment approach of treatable traits—especially in key “super traits” such as Type 2 (T2) inflammation, airflow limitation, poor asthma self-management, obesity, depression, and smoking—early in the course of asthma may help prevent persistent symptoms, exacerbations, reliance on oral corticosteroids (OCS), loss of lung function, and the phenomenon of “people remodelling” associated with extra-pulmonary traits and excessive OCS use (Hamada et al. 2026, Couillard et al, 2023 & Pavord, 2024). Focusing on early intervention can also reduce the risk of prolonged disease duration and ineffective treatment outcomes (Couillard et al, 2023)

This new paradigm of asthma management poses a brighter future for people with asthma, one that includes remission as a target, which was once never considered possible. If treated early and managed using a treatable traits approach, this could lead to fewer deaths and improved quality of life for people living severe asthma.