Remission in moderate-to-severe pediatric asthma: Definitions, assessment, prevalence, predictors, and outcomes-a scoping review.

BACKGROUND

Remission is emerging as a novel therapeutic target in asthma, particularly with the advent of biologic therapies. Although spontaneous remission is recognized in mild childhood asthma, little is known about the concept of remission in children with moderate-to-severe asthma.

OBJECTIVE

This study aimed to synthesize available evidence on definitions, assessment methods, prevalence, predictors, and long-term outcomes of remission in children with moderate-to-severe asthma.

METHODS

This scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidance. MEDLINE and EMBASE were searched from 2003 onward. Eligible studies included randomized clinical trials and observational studies involving children or adolescents with moderate-to-severe asthma that reported remission or remission-related subdomains.

RESULTS

Of 2076 records identified, 8 studies met inclusion criteria (1 trial, 7 observational). Definitions of remission varied substantially and predominantly relied on clinical criteria (absence of symptoms or medication use), with inconsistent incorporation of lung function and none including inflammatory biomarkers. Remission prevalence ranged widely, from 4% to 41.9%, with the highest rates observed in a recent biologic trial; however, assessment periods were highly variable, ranging from 24 weeks to 3 years. Predictors of a lower likelihood of remission included female sex, atopy, and older age at initial diagnosis. Available evidence suggests a persistent risk of subclinical inflammation and relapse despite achieving clinical remission.

CONCLUSIONS

Evidence on remission in moderate-to-severe pediatric asthma remains limited and heterogeneous, often in the context of ongoing treatment. Standardized, multidomain definitions are urgently needed to inform treat-to-target strategies and future clinical trials.