Pioneering a paradigm shift in asthma management: remission as a treatment goal

Until 2023, guidelines focused on asthma control as the primary goal of asthma treatment,1 with the step-wise addition of drugs until the best possible disease control was achieved (figure). Phenotyping was optional. One drug could simply be added to another following the standard scheme, with treatment failure rather than the presence of a particular characteristic being the stimulus for treatment escalation. The more severe the disease, the more drugs in increasing doses were given. Patients with severe asthma were, therefore, treated with multiple drugs at high doses, often with substantial side-effects.