ON-TREATMENT ASTHMA REMISSION:
MOVING BEYOND CONTROL

Proposed Framework for Remission1-13

Remission: A state or period with low to no disease activity
that can be spontaneous or as a result of therapy10

Several Groups Across Countries Have Recommended Clinical Remission Definitions1-5

* The US workgroup determined that symptom and lung function criteria must be met on all occasions measured in the previous 12-month period with a minimum of two measurements during the year.

The definition of on-treatment remission in asthma has not yet been established
and further consensus among experts, guidelines, and societies is warranted.

This tool showcases the evolving evidence around asthma remission as of December 2025 and is intended for educational purposes only.

ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; AirQ, Asthma Impairment and Risk Questionnaire; BD, bronchodilator; FEV11, forced expiratory volume in 1 second;
ICS, inhaled corticosteroids; ISAR, International Severe Asthma Registry; OCS, oral corticosteroids.

1. Lommatzsch M, et al. S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023 [S2k guidelines for specialist diagnostics and treatment of asthma 2023]. Published by the German Respiratory Society (DGP) 6 March 2023. Accessed 19 February 2026. https://register.awmf.org/assets/guidelines/020-009l_S2k_Fachaerztliche-Diagnostik-Therapie-von-Asthma_2023-03.pdf. 2. Álvarez-Gutiérrez FJ, et al. Arch Bronconeumol. 2024;60(8):503–509. 3. Canonica GW, et al. J Allergy Clin Immunol Pract. 2023;11(12):3629–3637. 4. Nagase H, et al. Allergol Int. Published online December 4, 2025. https://doi.org/10.1016/j.alit.2025.11.004. 5. Blaiss M, et al. Ann Allergy Asthma Immunol. 2023;131(6):782–785. 6. Katial RK, et al. J Allergy Clin Immunol. 2025;156(3S):S20–S24 7. Hansen S, et al. Chest. 2024;165(2):253–266. 8. McDowell PJ, et al. Eur Respir J. 2023;62(6):2300819. 9. Shin SH, et al. Tuberc Respir Dis (Seoul). Published online December 9, 2025. doi:10.4046/trd.2025.0161. 10. Perez-de-Llano L, et al. Am J Respir Crit Care Med. 2024;210(7):869–880. 11. Menzies-Gow A, et al. J Allergy Clin Immunol. 2020;145(3):757–765. 12. Thomas D, et al. Eur Respir J. 2022;60(5):2102583. 13. Bieber T. Nat Rev Drug Discov. 2023;22(8):662–680. 14. Busse WW, et al. Eur Respir Rev. 2022;31(163):210183. 15. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Updated 2025. Accessed 4 December 2025. https://ginasthma.org/ 16. Lommatzsch M, et al. Lancet. 2022;399(10335):1664–1668. 17. Barach AL. J Am Med Assoc. 1951;147(8):730–737. 18. Sullivan TJ. Pediatr Clin North Am. 1992;39(6):1363–1382. 19. Upham JW, James AL. Pharmacol Ther. 2011;130(1):38–45. 20. Crompton G. Prim Care Respir J. 2006;15(6):326–331.

EVOLUTION OF ON-TREATMENT
REMISSION IN ASTHMA

The GINA report outlines a framework for clinical and complete remission in children and adults, both off treatment and on treatment, providing examples of criteria for clinical and complete remission:

Examples of proposed criteria for
on-treatment clinical remission in adults:

Examples of proposed criteria for
on-treatment complete remission in adults:

No asthma symptoms
No exacerbations
No use of OCS
Stable or improving lung function
Normal lung function
Normalization of airway responsiveness
and/or inflammatory markers

The framework does not provide a remission consensus; however, it does state that baseline predictors
of remission on treatment include better ACQ/ACT scores, better lung function, fewer comorbidities,
earlier asthma onset, and no or lower maintenance OCS use

On-Treatment Clinical Remission in Asthma Over the Last 70 Years

Remission may be achieved on or off treatment. Different definitions of remission have been proposed and
implemented in various studies. Given this evolving framework for remission, further studies may provide
a pathway to inform our understanding of disease modification in severe asthma.

This tool showcases the evolving evidence around asthma remission as of December 2025 and is intended for educational purposes only.

ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroids; LABA, long-acting beta agonist; OCS, oral corticosteroids; SABA, short-acting beta agonist; SCS, systemic corticosteroids.

1. Lommatzsch M, et al. S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023 [S2k guidelines for specialist diagnostics and treatment of asthma 2023]. Published by the German Respiratory Society (DGP) 6 March 2023. Accessed 19 February 2026. https://register.awmf.org/assets/guidelines/020-009l_S2k_Fachaerztliche-Diagnostik-Therapie-von-Asthma_2023-03.pdf. 2. Álvarez-Gutiérrez FJ, et al. Arch Bronconeumol. 2024;60(8):503–509. 3. Canonica GW, et al. J Allergy Clin Immunol Pract. 2023;11(12):3629–3637. 4. Nagase H, et al. Allergol Int. Published online December 4, 2025. https://doi.org/10.1016/j.alit.2025.11.004. 5. Blaiss M, et al. Ann Allergy Asthma Immunol. 2023;131(6):782–785. 6. Katial RK, et al. J Allergy Clin Immunol. 2025;156(3S):S20–S24 7. Hansen S, et al. Chest. 2024;165(2):253–266. 8. McDowell PJ, et al. Eur Respir J. 2023;62(6):2300819. 9. Shin SH, et al. Tuberc Respir Dis (Seoul). Published online December 9, 2025. doi:10.4046/trd.2025.0161. 10. Perez-de-Llano L, et al. Am J Respir Crit Care Med. 2024;210(7):869–880. 11. Menzies-Gow A, et al. J Allergy Clin Immunol. 2020;145(3):757–765. 12. Thomas D, et al. Eur Respir J. 2022;60(5):2102583. 13. Bieber T. Nat Rev Drug Discov. 2023;22(8):662–680. 14. Busse WW, et al. Eur Respir Rev. 2022;31(163):210183. 15. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Updated 2025. Accessed 4 December 2025. https://ginasthma.org/ 16. Lommatzsch M, et al. Lancet. 2022;399(10335):1664–1668. 17. Barach AL. J Am Med Assoc. 1951;147(8):730–737. 18. Sullivan TJ. Pediatr Clin North Am. 1992;39(6):1363–1382. 19. Upham JW, James AL. Pharmacol Ther. 2011;130(1):38–45. 20. Crompton G. Prim Care Respir J. 2006;15(6):326–331.

REDUCING EXACERBATIONS
IS PROPOSED AS A FUNDAMENTAL
CRITERION OF ASTHMA REMISSION1-15

Controlled Asthma15,21*

<2 exacerbations per year requiring OCS
or <1/year requiring hospitalization

On-Treatment Clinical Remission1-15

For ≥12 Months

Zero exacerbations

*Adapted from GINA and ERS/ATS.
ATS, American Thoracic Society; BD, bronchodilator; ERS, European Respiratory Society; FEV1, forced expiratory volume in 1 second; GINA, Global Initiative for Asthma.

ACHIEVING LUNG FUNCTION STABILIZATION
OR IMPROVEMENT IS A PROPOSED KEY
COMPONENT OF ASTHMA REMISSION1-15

Controlled Asthma15,21*

FEV1pp ≥80%

On-Treatment Clinical Remission1-15

For ≥12 Months

Stable or optimized lung function

*Adapted from GINA and ERS/ATS. †n=1865; Cox proportional hazard model analysis adjusted for age at index date, smoking status, body mass index, gender, rhinitis, chronic sinusitis, nasal polyps,
atopic dermatitis, diabetes, anaphylaxis, ischemic heart disease, heart failure, food allergy, anxiety, depression, and psoriasis.21 ‡n=1075; relative risk of death from asthma during 25 years of follow-up.26
ATS, American Thoracic Society; BD, bronchodilator; CI, confidence interval; ERS, European Respiratory Society; FEV1, forced expiratory volume in 1 second; FEV1pp, FEV1 percent predicted; GINA, Global Initiative for Asthma; HR, hazard ratio.

ZERO OCS USE IS GENERALLY REQUIRED
FOR A STATE OF ASTHMA REMISSION1-15

Controlled Asthma15,21*

<2 exacerbations per year requiring OCS
or <1/year requiring hospitalization

On-Treatment Clinical Remission2-8,10

For ≥12 Months

Zero exacerbations requiring OCS

*Adapted from GINA and ERS/ATS. †P<0.001.25
AE, adverse event; ATS, American Thoracic Society; ERS, European Respiratory Society; GI, gastrointestinal; GINA, Global Initiative for Asthma; OCS, oral corticosteroids.

LONG-TERM SYMPTOM CONTROL IS GENERALLY
AN IMPORTANT PATIENT-REPORTED
COMPONENT OF ASTHMA REMISSION1-15

Controlled Asthma15,21*

ACQ ≤1.5 or ACT ≥20

On-Treatment Clinical Remission1-15

For ≥12 Months

ACQ ≤1.5 or ≤0.75; or ACT ≥20

*Adapted from GINA and ERS/ATS.
ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; ATS, American Thoracic Society; BD, bronchodilator; ERS, European Respiratory Society; FEV1, forced expiratory flow in 1 second; GINA, Global Initiative for Asthma.

  1. Lommatzsch M, et al. S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023 [S2k guidelines for specialist diagnostics and treatment of asthma 2023]. Published by the German Respiratory Society (DGP) 6 March 2023. Accessed 19 February 2026. https://register.awmf.org/assets/guidelines/020-009l_S2k_Fachaerztliche-Diagnostik-Therapie-von-Asthma_2023-03.pdf.
  2. Álvarez-Gutiérrez FJ, et al. Arch Bronconeumol 2024;60(8):503–509.
  3. Canonica GW, et al. J Allergy Clin Immunol Pract. 2023;11(12):3629–3637.
  4. Nagase H, et al. Allergol Int. Published online December 4, 2025. https://doi.org/10.1016/j.alit.2025.11.004. Accessed 19 February 2026. https://jasweb.or.jp/guideline.html.
  5. Blaiss M, et al. Ann Allergy Asthma Immunol. 2023;131(6):782–785.
  6. Katial RK, et al. J Allergy Clin Immunol. 2025;156(3S):S20–S24.
  7. Hansen S, et al. Chest. 2024;165(2):253–266.
  8. McDowell PJ, et al. Eur Respir J. 2023;62(6):2300819.
  9. Shin SH, et al. Tuberc Respir Dis (Seoul). Published online December 9, 2025. doi:10.4046/trd.2025.0161.
  10. Perez-de-Llano L, et al. Am J Respir Crit Care Med. 2024;210(7):869–880.
  11. Menzies-Gow A, et al. J Allergy Clin Immunol. 2020;145(3):757–765.
  12. Thomas D, et al. Eur Respir J. 2022;60(5):2102583.
  13. Bieber T. Nat Rev Drug Discov. 2023;22(8):662–680.
  14. Busse WW, et al. Eur Respir Rev. 2022;31(163):210183.
  15. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Updated 2025. Accessed 4 December 2025. https://ginasthma.org/
  16. Lommatzsch M, et al. Lancet. 2022;399(10335):1664–1668.
  17. Barach AL. J Am Med Assoc. 1951;147(8):730–737.
  18. Sullivan TJ. Pediatr Clin North Am. 1992;39(6):1363–1382.
  19. Upham JW, James AL. Pharmacol Ther. 2011;130(1):38–45.
  20. Crompton G. Prim Care Respir J. 2006;15(6):326–331.
  21. Chung KF, et al. Eur Respir J. 2014;43(2):343–373.
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  23. Sullivan PW, et al. J Allergy Clin Immunol. 2018;141(1):110–116.e7.
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  29. Barnes PJ, et al. Allergy. 2014;69(9):1119–1140.
  30. Juniper EF, et al. Respir Med. 2006;100(4):616–621.
  31. Schatz M, et al. J Allergy Clin Immunol. 2006;117(3):549–556.
  32. Schatz M, et al. J Allergy Clin Immunol. 2009;124(4):719–23.e1.