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Peer-reviewedCC BYJournal of clinical medicine

Beyond Symptom Control: Remission as a Depth-Stratified Treatment Goal in Severe Asthma

  • Martina Votto1
  • Fabio Manzo2
  • Mauro Maniscalco3,4
  • Giorgio Castellana5
  • Giuseppe Cascone6
  • Agostino Buonauro7
  • Antimo Papa8
  • Roberto Formisano8
  • Christian Basile9,10
  • Guido Grassi11
  • Pasquale Ambrosino12
12 affiliations
  1. 1Maternity and Paediatric Department, Azienda Sanitaria Locale, 82100 Benevento, Italy
  2. 2Fleming Clinical Laboratory, 81020 Casapulla, Italy
  3. 3Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
  4. 4Department of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy
  5. 5Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Bari Institute, 70124 Bari, Italy
  6. 6Centro Medicina del Lavoro Vesuvio, 80035 Nola, Italy
  7. 7Cardiology Unit, “Santa Maria della Pietà” Hospital, Local Health Authority Napoli 3 Sud (ASL Napoli 3 Sud), 80035 Nola, Italy
  8. 8Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
  9. 9Department of Clinical Science and Education, Karolinska Institutet, 171 77 Stockholm, Sweden
  10. 10ANMCO Research Center, Heart Care Foundation, 50121 Florence, Italy
  11. 11Department of Medicine and Surgery, University of Milano-Bicocca, 20162 Milano, Italy
  12. 12Istituti Clinici Scientifici Maugeri IRCCS, Medical Directorate of Telese Terme Institute, 82037 Telese Terme, Italy
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Abstract

The management of severe asthma has shifted from symptom control to the ambition of remission, a goal borrowed from rheumatology. Biologics targeting immunoglobulin E, interleukin-5 and its receptor, the interleukin-4 receptor alpha subunit, and thymic stromal lymphopoietin have made sustained quiescence realistic for many patients, yet estimates that roughly one-third achieve remission shift by tens of percentage points depending on the definition used. This narrative review advances two linked arguments. First, that the heterogeneity of definitions, not any shortage of effective agents, is the central obstacle to using remission as a treatment target. Second, that remission is best read as a multidimensional construct in which clinical, functional and biological quiescence are distinct axes, reached independently and often discordantly, with complete remission denoting their convergence rather than the last step of a sequence. Where each biologic acts within the type 2 cascade determines which biomarkers move under treatment and, only hypothetically, how deep remission can reach. Structural remodeling and the fact that current agents suppress rather than reset inflammation cap that depth, so remission remains a pharmacologically maintained state on treatment. Concomitant chronic rhinosinusitis with nasal polyps is treated as a modifier of asthma remission rather than a separate endpoint. The framework is conceptual and unvalidated. The priority is a harmonized, depth-resolved definition, explicit about treatment burden and patient-centered outcomes, against which any therapy can be judged.

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Cite

BibTeXRIS
BibTeX
@article{votto2026beyond,
  title = {{Beyond Symptom Control: Remission as a Depth-Stratified Treatment Goal in Severe Asthma}},
  author = {Martina Votto and Fabio Manzo and Mauro Maniscalco and Giorgio Castellana and Giuseppe Cascone and Agostino Buonauro and Antimo Papa and Roberto Formisano and Christian Basile and Guido Grassi and Pasquale Ambrosino},
  journal = {Journal of clinical medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15197686},
  url = {https://europepmc.org/article/PMC/PMC13665759},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Beyond Symptom Control: Remission as a Depth-Stratified Treatment Goal in Severe Asthma
AU  - Martina Votto
AU  - Fabio Manzo
AU  - Mauro Maniscalco
AU  - Giorgio Castellana
AU  - Giuseppe Cascone
AU  - Agostino Buonauro
AU  - Antimo Papa
AU  - Roberto Formisano
AU  - Christian Basile
AU  - Guido Grassi
AU  - Pasquale Ambrosino
PY  - 2026
DA  - 2026/10/01
JO  - Journal of clinical medicine
DO  - 10.3390/jcm15197686
UR  - https://europepmc.org/article/PMC/PMC13665759
AB  - The management of severe asthma has shifted from symptom control to the ambition of remission, a goal borrowed from rheumatology. Biologics targeting immunoglobulin E, interleukin-5 and its receptor, the interleukin-4 receptor alpha subunit, and thymic stromal lymphopoietin have made sustained quiescence realistic for many patients, yet estimates that roughly one-third achieve remission shift by tens of percentage points depending on the definition used. This narrative review advances two linked arguments. First, that the heterogeneity of definitions, not any shortage of effective agents, is the central obstacle to using remission as a treatment target. Second, that remission is best read as a multidimensional construct in which clinical, functional and biological quiescence are distinct axes, reached independently and often discordantly, with complete remission denoting their convergence rather than the last step of a sequence. Where each biologic acts within the type 2 cascade determines which biomarkers move under treatment and, only hypothetically, how deep remission can reach. Structural remodeling and the fact that current agents suppress rather than reset inflammation cap that depth, so remission remains a pharmacologically maintained state on treatment. Concomitant chronic rhinosinusitis with nasal polyps is treated as a modifier of asthma remission rather than a separate endpoint. The framework is conceptual and unvalidated. The priority is a harmonized, depth-resolved definition, explicit about treatment burden and patient-centered outcomes, against which any therapy can be judged.
SN  - 2077-0383
ER  -