Severe Asthma – Is There a Chance for a New Beginning? An Expert Look at the Potential for Lasting Change
- Health Communicator
- Jun 22
- 5 min read
Updated: Jul 10
The information presented here is based on the latest scientific consensus published in the article “Disease Modification in Asthma: Are We on the Right Way? A Multidisciplinary Expert Delphi Consensus (MODIASTHMA Consensus)”, featured in the Journal of Asthma and Allergy in 2024. The author team is multidisciplinary and includes leading experts in allergology, pulmonology, and pediatrics from university and specialized hospitals in Spain. These specialists bring extensive practical and research experience and include: Juan Carlos Miralles-López, Francisco J. Alvarez-Gutiérrez, Julio Delgado-Romero, Santiago Quirce, Jose Gregorio Soto-Campos, Ruben Andújar-Espinosa, Sheila Cabrejos-Perotti, Manuel Castilla-Martínez, Isabel Flores-Martín, Manuel José Pajarón-Fernández, and José Valverde-Molina.
Their analysis and recommendations are based on collaboration among 192 experts and the most up-to-date scientific data. They address key questions that matter to patients with severe asthma and their families—specifically, the possibility of fundamentally altering the course of the disease through modern therapies.
“Modern science is setting a new goal for asthma treatment: not just symptom control, but actual disease modification—and the restoration of hope for lasting improvement.”
Expert Insights
With the advancement of biological therapies and a deeper understanding of the mechanisms behind asthma, medical science is now aiming for more than just symptom control. The focus is shifting toward a fundamental transformation in the disease's progression—known as disease modification. This shift is crucial not only for patients with severe asthma but also for their families, because the stakes involve not just relief but potentially changing the overall prognosis of the disease.
What are the most current expert opinions and areas of consensus? What criteria and indicators are recommended? What are the realistic prospects for remission, or even reversal or halting of the pathological processes in the airways?
Below are five of the most important expert positions and scientific insights from the latest multidisciplinary consensus, along with explanations to help patients and families understand and navigate the options.
1. What Are the Mandatory Criteria for “Disease Modification” in Asthma?
Expert Consensus:
“Five core criteria are identified as mandatory for defining disease modification in asthma:
Complete resolution of signs and symptoms;
Normalization of biomarkers/biological activity;
Reversal of bronchial hyperreactivity;
Improvement or stabilization of structural abnormalities in the airways;
Long-term maintenance of this state, for at least three years.” — MODIASTHMA Consensus
Explanation: True disease modification goes beyond temporary symptom control. It requires a sustained change that is confirmed by objective measurements—not just how the patient feels, but also lab results and functional testing.
2. How Is Asthma Activity Measured and Monitored?
Expert Opinion:
“A validated, objective, and multidimensional assessment of disease activity is necessary.” — MODIASTHMA Consensus
Explanation: Asthma is a complex condition. A single measurement (like breathing tests) isn’t enough. The modern approach combines several types of tests—for example: pulmonary function tests (spirometry, FEV1), inflammation markers (FeNO, eosinophil count), and clinical symptom assessments. This approach allows for earlier detection of negative trends and timely therapy adjustments.
3. What Is the Role of Biologic Therapies in Modifying the Disease?
From the Article:
“The role of biologics in controlling disease activity is clear, provided the patient’s phenotype is accurately identified. However, their potential to modulate, stop, or even reverse structural damage remains to be clarified.”
Explanation: While there is solid evidence that biologic therapies can effectively control asthma attacks and symptoms, it’s still uncertain whether they can reverse structural changes (known as airway remodeling). However, early data is promising—especially when treatment begins early and is maintained long term.
4. What Markers and Approaches Are Recommended to Track Lasting Disease Change?
Expert Opinion:
“Indicators that predict progressive lung function loss should be used. Asthma should be monitored over time, evaluating both achievement and maintenance of clinical remission.”
Explanation: The key lies in long-term tracking of lung function and structural changes. This can be done through regular spirometry, oscillometry, and high-resolution imaging. Monitoring allows physicians to assess the real impact of therapy and predict risks of worsening. For patients and families, this means that even when symptoms are under control, regular monitoring and communication with the healthcare team remain essential.
5. What Are the Challenges and Unanswered Questions?
From the Article:
“More evidence is needed to determine the reversibility of remodeling, the validated biomarkers that predict response to biologic therapies, and when therapy can be discontinued after achieving a ‘long-term disease-free’ state.”
Explanation: There are still many unanswered questions in the science:
Which patients will benefit most?
What are the best markers of treatment success?
When (and how) can treatment be safely stopped?
Patients and their families should expect a personalized approach and stay informed as science continues to evolve.
Frequently Asked Questions
1. What Does “Remission” Mean in Asthma, and How Common Is It With Biologic Therapies?
Answer: The article emphasizes that remission is a new treatment goal in asthma. It requires not only the absence of severe symptoms and attacks for at least 12 months, but also stabilization of lung function—and mutual agreement between doctor and patient that remission has been achieved. In complete remission, the underlying disease processes also normalize.
Studies show that the percentage of patients achieving remission with biologic therapy varies:
Up to 42% after 24 months with benralizumab,
Up to 46.8% over 6 years with mepolizumab,
About 42.8% over two years with dupilumab.
This offers hope that, with proper treatment and monitoring, more people may achieve lasting control or remission.
2. Is It Possible to Reverse or Halt Airway Remodeling?
Answer: One of the major hopes with new biologic treatments is their potential to slow, stop, or even reverse airway remodeling—the structural changes that cause breathing difficulties and permanent damage. There is early evidence supporting this potential, but it’s not yet clear if this can be achieved for all patients. Early and sustained treatment appears to be crucial. New clinical trials are ongoing to further investigate this possibility.
3. How Can I Tell if My Disease Is Actually Improving Long-Term and Not Just Temporarily?
Answer: Long-term improvement is tracked not just through symptom monitoring, but also through regular lung function tests (such as spirometry and FEV1), high-resolution imaging (like CT scans), and biomarker analysis (e.g., FeNO, eosinophils). The article highlights the importance of tracking the trend in lung function over time—whether it is declining or stabilizing—rather than just checking current levels.
4. Why Is It Important to Consider Other Coexisting Conditions (Comorbidities) in Severe Asthma?
Answer: The article notes that comorbidities—such as gastroesophageal reflux, allergic rhinitis, obesity, depression, diabetes, and cardiovascular disease—can significantly worsen asthma symptoms and affect treatment effectiveness. Special attention is given to upper airway diseases (like chronic rhinosinusitis with nasal polyps), which share inflammatory pathways with asthma. Ignoring these conditions can reduce treatment success, so a multidisciplinary approach is recommended.
5. What Are the Limitations and Open Questions for the Future of Biologic Therapy?
Answer: While biologics offer new hope, the article outlines some limitations:
It’s not fully understood which patients will benefit most or the ideal timing for starting therapy.
It’s unclear when (or if) treatment can be safely stopped after achieving long-term disease-free status.
Not all clinical trial results may reflect real-world outcomes—factors like treatment adherence and drug availability matter.
This means patients should stay informed, maintain regular dialogue with their care team, and keep up with emerging scientific findings.
Conclusion
The findings outlined in this publication show that care for patients with severe asthma is entering a new era. The goal is no longer just to manage flare-ups, but to actively pursue long-term remission and even disease modification. While the medical community is still working toward definitive answers on reversing structural changes and identifying the best individualized strategies, the growing body of evidence provides reason for optimism.
Patients and their families can look forward to more precise diagnostics, personalized treatments, and multidisciplinary support as science continues to search for the best ways to achieve lasting improvements in quality of life with asthma.
Source Miralles-López JC, et al. “Disease Modification in Asthma: Are We on the Right Way? A Multidisciplinary Expert Delphi Consensus (MODIASTHMA Consensus).” Journal of Asthma and Allergy. 2024;17:1163–1171. https://doi.org/10.2147/JAA.S488764
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