Bridging the gap between clinical outcomes and patient experiences in asthma: a targeted review of exacerbation, control, and remission outcomes

OBJECTIVE: Understanding patients' lived experiences are vital for evaluating new treatments, yet patients' perspectives remain underutilized in asthma clinical trials. This study explored how asthma exacerbations, control, and remission are conceptualized and/or measured in clinical guidelines/expert recommendations and recent primary research studies, and the extent that patient perspectives were incorporated. DATA SOURCES: A targeted literature review was conducted using electronic databases, ClinicalTrials.gov, regulatory websites, and reference lists. STUDY SELECTIONS: Conceptualizations of asthma exacerbations, control, and remission were analyzed using content analysis, and measurement strategies in recent primary research studies were extracted to evaluate alignment. RESULTS: Exacerbations, control, and remission are interrelated concepts but lack universally accepted definitions, with inconsistencies across published sources and limited alignment between patients and clinicians. Although there was some alignment on what constitutes a severe exacerbation, the patient perspective was not well-captured. Asthma control was more consistently defined and measured using tools such as the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT), however there are still opportunities for making control endpoints more patient-informed. For remission, clinical guidelines emphasized symptom reduction/absence and improved lung function, however the role of treatment and timeframe imposed varied. Few primary research studies measured remission, and patient conceptualizations of remission were limited. CONCLUSIONS: Greater alignment between clinical trial endpoints and patient-reported experiences is needed. The lack of consensus complicates the development of standardized, patient-informed measurement approaches, and should be addressed in the development of novel asthma endpoints.