{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:47:03Z","timestamp":1791953223649,"version":"4.3.4"},"reference-count":53,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>The management of severe asthma has shifted from symptom control to the ambition of remission, a goal borrowed from rheumatology. Biologics targeting immunoglobulin E, interleukin-5 and its receptor, the interleukin-4 receptor alpha subunit, and thymic stromal lymphopoietin have made sustained quiescence realistic for many patients, yet estimates that roughly one-third achieve remission shift by tens of percentage points depending on the definition used. This narrative review advances two linked arguments. First, that the heterogeneity of definitions, not any shortage of effective agents, is the central obstacle to using remission as a treatment target. Second, that remission is best read as a multidimensional construct in which clinical, functional and biological quiescence are distinct axes, reached independently and often discordantly, with complete remission denoting their convergence rather than the last step of a sequence. Where each biologic acts within the type 2 cascade determines which biomarkers move under treatment and, only hypothetically, how deep remission can reach. Structural remodeling and the fact that current agents suppress rather than reset inflammation cap that depth, so remission remains a pharmacologically maintained state on treatment. Concomitant chronic rhinosinusitis with nasal polyps is treated as a modifier of asthma remission rather than a separate endpoint. The framework is conceptual and unvalidated. The priority is a harmonized, depth-resolved definition, explicit about treatment burden and patient-centered outcomes, against which any therapy can be judged.<\/jats:p>","DOI":"10.3390\/jcm15197686","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:57:46Z","timestamp":1791197866000},"page":"7686","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Symptom Control: Remission as a Depth-Stratified Treatment Goal in Severe Asthma"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4271-8649","authenticated-orcid":false,"given":"Martina","family":"Votto","sequence":"first","affiliation":[{"name":"Maternity and Paediatric Department, Azienda Sanitaria Locale, 82100 Benevento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7493-5954","authenticated-orcid":false,"given":"Fabio","family":"Manzo","sequence":"additional","affiliation":[{"name":"Fleming Clinical Laboratory, 81020 Casapulla, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-9921","authenticated-orcid":false,"given":"Mauro","family":"Maniscalco","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy"},{"name":"Department of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4019-0585","authenticated-orcid":false,"given":"Giorgio","family":"Castellana","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Bari Institute, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Cascone","sequence":"additional","affiliation":[{"name":"Centro Medicina del Lavoro Vesuvio, 80035 Nola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agostino","family":"Buonauro","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u201cSanta Maria della Piet\u00e0\u201d Hospital, Local Health Authority Napoli 3 Sud (ASL Napoli 3 Sud), 80035 Nola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antimo","family":"Papa","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Formisano","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4680-3058","authenticated-orcid":false,"given":"Christian","family":"Basile","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Karolinska Institutet, 171 77 Stockholm, Sweden"},{"name":"ANMCO Research Center, Heart Care Foundation, 50121 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Grassi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, 20162 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9398-0428","authenticated-orcid":false,"given":"Pasquale","family":"Ambrosino","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Medical Directorate of Telese Terme Institute, 82037 Telese Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/s41573-023-00750-1","article-title":"Type 2 chronic inflammatory diseases: Targets, therapies and unmet needs","volume":"22","author":"Kolkhir","year":"2023","journal-title":"Nat. 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