Examining Asthma Remission
I have been going through a period of disease change. I am trying to get a handle on what this means and what to do. In my research, I have discovered that there does not seem to be any definite consensus on how to define remission. This becomes further complicated by the confusion between remission and disease progression.
Have you been told that your asthma is in remission?
I have never been told this specifically, however, there are a variety of theories that my asthma was in fact in remission for the majority of my teen years and twenties. When I asked my parents what they remembered hearing is the phrase, “She'll grow out of it” or ...maybe she has grown out of it”. Was this your experience as well?
Interestingly, many studies that have examined remission include the lack of respiratory symptoms for approximately 1 year and medication use as criteria. Other studies have expanded that definition to also use normal lung function and/or the absence of bronchial hyperresponsiveness as additional criteria.1
The role of cellular inflammation in asthma remission
In a study by Van de Toom et al. they examined evidence of ongoing cellular inflammation during periods of remission and if this could be a predictor of relapse later in life.2 The study identified cellular presence through more typically invasive methods such a biopsy. They were able to identify that underlying evidence of inflammation may be present during remission. In particular, the study looked at the thickening of the reticular basement membrane and its plausible correlation to airway remodeling. They hypothesized that by identifying inflammatory changes, they can better predict patients that may need and respond to ongoing anti-inflammatory treatment. I like to think of this as while things on the outside may look good, there may be things on the inside that are still kicking up a storm. The biomarkers that the studied identified for asthma monitoring may be ones that you are very familiar with, these include nitric oxide, blood eosinophils or monitoring of airway responsiveness testing, such as methacholine challenges. In their study, they identified patients that were noted to be in remission that had evidence of subclinical inflammation as identified via biomarkers. This inflammation was similar to patients with active asthma.
Researchers are still working through definitions etc., however, it is important to have your asthma monitored in good times and bad. In a discussion with my doctor, we were discussing the complexity of the underlining inflammation and its role in asthma and also the need for that inflammation to be controlled. While not everything is known about the process, it looks like I will be a lifelong user of anti-inflammatory treatment for my asthma. There is also a thought that this will also combat exacerbations.
Have you had an experience with ongoing inflammatory monitoring or tweaking of anti-inflammatory treatment during periods of well-controlled asthma? I would love to know more about your asthma remission experiences.
What has your experience with Singulair been like?