Asthma therapy concepts through the ages.

The development and approval of DMAADs ("disease-modifying anti-asthmatic drugs"), in particular inhaled steroids (alone or in combination with long-acting bronchodilators), biologics and modern allergen immunotherapies, has fundamentally changed the asthma therapy concept from symptom control to symptom prevention. This concept is linked to the new asthma treatment goal of asthma remission: long-term absence of symptoms (good asthma control), absence of exacerbations, and stable lung function, without the use of systemic steroids for asthma therapy. Three types of asthma remission are distinguished: spontaneous remission (e.g., childhood asthma), remission "off treatment" (e.g., after successful allergen immunotherapy), and remission "on treatment" (e.g., during inhaled therapy or biologic therapy). A treat-to-target approach is used, as in rheumatoid arthritis or chronic inflammatory bowel disease: The goal is to achieve asthma remission, through individually tailored treatment with highly effective drugs with minimal side effects. However, this requires precise phenotyping of the patient, including detailed history taking, pulmonary function diagnostics, allergological diagnostics, and measurement of type 2 biomarkers.