48 definitions later: What can COPD learn from asthma’s clinical remission journey?

ERS CONGRESS 2026 | RESPIRATORY PERSPECTIVES

By Glenn Cardwell, Associate Director, Medical Strategy and Hiral Amin, Principal, Medical Team

At ERS 2026, disease stability emerged as an important potential treatment goal in COPD. But as the field considers what stability should look like in practice, asthma offers a useful lesson for anyone shaping respiratory evidence and communications: an ambitious treatment goal is only as meaningful as the way it is defined and measured.

In severe asthma, clinical remission has been a focus for years, yet a consistent approach to measuring it remains elusive. While experts established a framework for remission in 2020, subsequent research has applied the concept in different ways, making results harder to interpret and compare.

COPD now has an opportunity to take a different path.

As disease stability gains prominence, the field can establish clearer, more consistent measures of success from the outset. For pharma, that creates an important opportunity to help shape how stability is defined, measured and communicated as the evidence evolves.

Why it matters to pharma

One systematic review found 48 unique remission definitions across 28 analyses of biologics in asthma, most without the patient–clinician agreement requested by the framework.^4,5 Without clear, consistent definitions behind those numbers, four things are at stake for COPD as disease stability becomes a more prominent goal:

• The numbers lose their meaning. Evidence-based medicine has been here before. The NNT is specific to one comparison, population and time period, yet is routinely quoted without that context; comparing two NNTs is valid only when population, disease stage, comparator, time period and outcomes match.⁶ Remission and stability rates are heading the same way. If every study defines stability its own way, clinicians and payers may struggle to interpret results, limiting confidence in the concept.
• One size won’t fit COPD. People with COPD tend to be older and carry more comorbidities, which GOLD 2026 now addresses in revised multimorbidity guidance.² The disease is progressive, so stability must reflect its trajectory, not just a “quiet” 12 months. The consequences and clinical meaning of achieving stability in early, inhaler-treated disease will differ significantly from severe disease needing a biologic.

In asthma, remission is less likely with longer-standing disease, maintenance oral corticosteroid use, obesity or depression⁴; COPD’s older population with more comorbidity makes reporting who was measured even more important.

• A concept to shape practice. The adoption of disease stability will define how COPD care evolves: what clinicians assess at review, when they act, and what counts as success.

“A remission or stability rate without its definition, time window and population is a headline, not a finding.”

Fortunately, COPD starts with an advantage: GOLD 2026 has already set out the concept of disease activity, along with definitions for disease control and stability.² It recommends stability be assessed through the lens of zero exacerbations, no worsening of health status and no accelerated lung function decline.² The subsequent variability lies in how clinical studies turn that guidance into protocol definitions, and that is where pharma can help.

Four actions pharma can take

Each of asthma’s lessons points to an action medical affairs can build into COPD strategy, plans and medical communications.

WITH GUIDELINE BODIES AND SOCIETIES

1 Build on GOLD: one framework, with levels.

Support associations and patient groups to align study definitions. Rather than one rigid definition, aim for one framework applied at different levels:

• A shared core of components
• Stage-specific thresholds from early to severe disease
• Common reporting rules

Asthma offers a useful precedent, setting out clinical and complete remission, on and off treatment, within one framework.³

WITH CLINICIANS

2 Never let a number travel alone.

Every remission or stability figure should carry four things:

1. Its definition: components and thresholds
2. Time window: how long it was sustained
3. Population: disease stage, biomarkers, prior treatment
4. Comparator: placebo or usual care

Pair results with practical tools: making disease activity assessment part of the annual-review framework. COPD care fundamentals then become the clinical tools through which physicians can aim for disease stability, embedding the shift from reactive care to a proactive, low-disease activity mindset.

WITH PATIENTS

3 Build the patient into the definition from the start.

The ERS 2026 theme was partnership between patients, clinicians and researchers⁷.

Work with patient advocacy groups to ask people across the range of airflow limitation what “stable” means to them. Assess patient perspectives on breathlessness, activity levels, or staying out of hospital, before the clinical composite is normalized. Although the 2020 asthma framework said remission should be refined through patient input³, patients and clinicians still differ deciphering on what it means.⁵

IN EVIDENCE PLANNING AND WITH PAYERS

4 Plan real-world evidence around disease stability.

Clinical trials offer a short, narrow window on a long and variable disease. Real-world evidence is where disease stability could offer payers a new perspective: whether patients remain stable in a more complex environment. That needs planning now. Agree which components registries and health records will capture and close any gaps — severe exacerbations are routinely recorded, but COPD-specific health status and lung function often are not.

What to watch next

With new target mechanisms being evaluated, imaging-based assessments evolving and guidance increasingly pointing toward earlier intervention, there has never been a more opportune time for COPD to define its next era.

Asthma showed that the respiratory community can embrace ambitious treatment goals. COPD can follow suit, but the order matters: define, agree, measure, then communicate. Getting that sequence right can help ensure disease stability becomes a meaningful measure of progress. The organizations that help it do so will be the partners clinicians trust as the evidence on disease. stability matures.

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References

1. ERS Congress 2026 scientific session. Towards remission in airway diseases: facing an unmet need or chasing a dream? September 5–9, 2026; Barcelona, Spain. 
2. Global Initiative for Chronic Obstructive Lung Disease. GOLD 2026 report. Summarized in U.S. Pharmacist, Updated GOLD 2026 report broadens COPD treatment guidance, December 1, 2025. 
3. Menzies-Gow A, Bafadhel M, Busse WW, et al. An expert consensus framework for asthma remission as a treatment goal. J Allergy Clin Immunol. 2020;145(3):757–765. 
4. Shackleford A, Heaney LG, Redmond C, McDowell PJ, Busby J. Clinical remission attainment, definitions, and correlates among patients with severe asthma treated with biologics: a systematic review and meta-analysis. Lancet Respir Med. Published online November 2024. Summary: Usher Institute. 
5. Cojocaru E, Arcana RI, Radu S, Trofor AC, Cojocaru C. Challenges and opportunities in achieving asthma remission. J Clin Med. 2025;14(8):2835. 
6. McAlister FA. The “number needed to treat” turns 20 — and continues to be used and misused. CMAJ. 2008;179(6):549–553. 
7. European Respiratory Society. ERS Congress 2026 priority topics and theme. 
8. Chupp G, Hanania NA, Ross J, Wechsler M. Positioning biologics in asthma: GINA Step 5 and earlier treatment. HCPLive. Accessed September 8, 2026. See also the GINA 2026 reports.