Small Airways Dysfunction and Remission in Adults With Asthma: A Longitudinal Exploratory Analysis of the AssessmenT of smalL Airways involvemeNT In aSthma (ATLANTIS) Study - PubMed

3 days ago

Asthma remission is a feasible treatment goal, but definitions vary and predictive biomarkers are underexplored.
The ATLANTIS study analyzed 684 adult asthmatics, defining remission using 3-component (3C) and 4-component (4C) criteria.
3C remission includes ACQ-6 < 1.5, no maintenance oral corticosteroids, and no exacerbations; 4C adds a <10% decline in pre-bronchodilator FEV1% predicted.
Remission occurred in 48% (3C) and 45% (4C) of patients, with predictors including male sex, better lung function, fewer exacerbations, and fewer small airways symptoms (higher SADT).
A novel Low Disease Activity (LDA) score was developed using clinical variables and was associated with remission, improved QoL, and fewer future exacerbations.
Transcriptomic analyses revealed remission-associated upregulation of interleukin 4/13 signalling and downregulation of coagulation pathways, replicated in U-BIOPRED.
Small airways dysfunction (SAD) was associated with reduced asthma remission, and the LDA tool showed clinical utility in stratifying prospective asthma risk.
Key immunologic and haemostatic pathways may underpin remission, offering potential targets for future intervention.

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