Asthma remission appears possible with treatment
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Key takeaways:
- Remission of childhood onset asthma may be due to a change in environment.
- Biologics have “changed the landscape” for remission.
- Professional societies are now debating guidelines for defining remission.
SAN ANTONIO — Clinicians and researchers are beginning to explore whether asthma remission is possible, Corinne Young, FNP-C, FCCP, said during her presentation at the 16th Annual Allergy, Asthma & Immunology CME Conference.
“This is new and exciting stuff here,” said Young, president and founder of the Association of Pulmonary Advanced Practice Providers and director of advanced practice providers and clinical operations at Colorado Springs Pulmonary Consultants.
“We first started thinking about remission of asthma in kids,” she said. “We have these kids with childhood onset asthma, and they grew out of it, right? They had it, they grew out of it, and they go on to live this happy, lovely life.”
But that does not always happen with these children as they become adults, Young continued.
“Then they come to see pulmonary when they’re 40,” she said. “They’ve been having issues for a little while, just thinking it’s allergies.”
Instead of going completely into remission, Young suggested, children might experience a kind of “honeymoon” as they move away from home and live in a new environment free of triggers such as cat hair or secondhand smoke. But this honeymoon does not last forever.
“As their immune systems start aging, it oftentimes ends up coming back to get them,” Young said, as older patients begin experiencing respiratory complications.
However, remission still may be possible with current treatment, she said.
“Now we are seeing with these newer therapies, more aggressive therapies, the more we understand about inflammation, we are seeing clinical and complete remission in patients,” Young said.
There is a difference between clinical and complete remission, Young added.
In clinical remission, the patient is basically asymptomatic, lung function has stabilized, and the patient is not experiencing any exacerbations, she said, adding that it can come while the patient is on or off treatment.
“They’re feeling pretty darn good. They’re performing well,” Young said.
Patients who are no longer on any therapies and who are not experiencing any symptoms are considered in complete remission, Young continued.
“They also have normal diagnostics. Sometimes their eosinophils are normal when they previously may not have been. Sometimes their allergic triggers are better controlled. Maybe they did immunotherapy,” she said. “Again, that lung function is normal.”
Biologic treatment has “changed the landscape,” Young said, noting that she has had many patients who have gone into clinical remission with this therapy.
“We’d all have panic attacks when patients first started going on biologic therapies because they come back and see us in 3 months, and they would be, like, ‘I’m off everything! I’m just doing the shots,’” she said.
“And we’d be like, ‘Oh my God! Don’t do that! We don’t know what happens if you do that,’” Young said. “But now we’re actually seeing that some people can do that, and they are able to have complete remission of symptoms.”
Without therapy, these patients remain free of exacerbations and maintain good lung function.
“This is new,” she said.
Professional societies are now debating guidelines for remission, such as length of time without experiencing any symptoms and therapy dosages needed to remain symptom-free, she said, adding that there has not been a consistent consensus yet.
“That is something that they’re looking at right now,” she said.
However, Young noted that the Global Initiative for Asthma does not want physicians to consider asthma remission in children since it tends to come back later in adulthood. She added that there is “a lot of research happening” in asthma remission.
“If you can go to the CHEST conference in Boston this year, there’s a lot of sessions that they have already planned to talk about remission of asthma,” she said.