Identifying Super-Responders: a Review of the Road to Asthma Remission

Asthma is a chronic respiratory disease marked by heterogeneity and variable clinical outcomes. Recent therapeutic advances have highlighted patients achieving optimal outcomes, termed 'remission' or 'super-response.' This review examines the various definitions of these terms and explores how disease burden impedes the attainment of remission. We assessed multiple studies, including a recent systematic review and meta-analysis on biologic treatments for asthma remission. Our review highlights that Type 2 inflammation may be the strongest predictor of biologic response. Key comorbidities (e.g., obesity, mood disorders) and behavioral factors (e.g., poor adherence, improper inhalation technique, smoking) were identified as dominant traits limiting remission. Additionally, asthma burden and longer disease duration significantly restrict the potential for remission in severe asthma patients under the current treatment paradigm. We review the potential for a "Predict and Prevent" approach, which focuses on early identification of high-risk patients with type-2 inflammation and aggressive treatment to improve long-term asthma outcomes. In conclusion, this scoping review highlights unmet needs in asthma remission, including: (i) a harmonized global definition, with better defined lung function parameters (ii) integration of non-biologic therapies into remission strategies, and (iii) a clinical trial of early biological intervention in remission-prone, very type-2 high, moderately severe asthmatics with clinical remission as a predefined primary endpoint. TRIAL REGISTRATION: Not applicable.