Health Care Providers and Patients Have Differing Views on Asthma Remission

The Global Initiative for Asthma (GINA) was established more than 30 years ago to improve the management of asthma. In asthma management, clinical or complete remission (see Table) while both off and on treatment is a relatively new care concept and treatment goal. However, clinicians and treatment teams may not agree on the definition of remission, and there is no validated instrument for patient-reported outcome measures. In addition, all health care providers do not necessarily understand what asthma remission looks like and may need training to recognize it.¹

Table. Criteria for Asthma Remission

The most recent GINA report, published in May 2024, emphasizes that clinicians should consider patient goals and whether they’ve been achieved because they may differ from the treatment team’s treatment goals and desired long-term outcomes.¹ Although there is a need for patient-reported outcome measures to be factored into remission, researchers and clinicians find this difficult because patient report is subjective, variable, and dependent on expectations.² In addition, researchers need to refer to the FDA’s guidance on developing patient-reported outcome measures. Because the ideal population would be diverse in ethnicity, age, and other factors, this guidance offers tips to ensure patient reported outcomes are reliable.¹

Patients may consider themselves in clinical remission if they have fewer exacerbations or adverse effects of oral corticosteroids (e.g., anxiety, cataracts, diabetes, osteoporosis, sleep disturbances, weight gain). Some patients may feel they are in remission if they have a reduced emotional burden from asthma and are able to enjoy activities of daily living and an improved quality of life.¹

A team of researchers address this issue in the September 2024 issue of The Lancet. In assessing asthma remission, in addition to the objective clinical measures that are available, a standardized and validated measure needs to be developed to consider the patient perspective, including their values and goals.²

In many diseases, research has proven that clinicians and patients have different ideas about treatment goals, adherence, and what constitutes remission. Patient expectations may be unrealistic; clinicians’ expectation might be misaligned with the patient’s goals. For patients who experience remission, it is imperative that health care providers, including pharmacists, counsel on the importance of continuing maintenance asthma medications since apparent remission may not indicate cure.

REFERENCES

1. Global Initiative for Asthma. 2024 Global Strategy for Asthma Management and Prevention. Updated 2024. Accessed January 22, 2025. https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf

2. Chan AHY, Leong P, Politis J, McDonald VM, Bardin P. Patient-reported outcomes: missing in asthma remission. Lancet Respir Med. 2024;12(9):665-666. doi:10.1016/S2213-2600(24)00242-X