milorad kravic/GettyAsthma is conventionally viewed as “treatable but incurable”. In other words, we can manage its symptoms but not reverse the underlying condition.But advances in science are challenging this view and we think a cure may be within reach.So what might a cure for asthma actually mean for the nearly 2.8 million Australians and an estimated 363 million people globally with asthma? And how could we get there?We’re both part of the CURE Asthma initiative – a coalition of researchers and clinicians – with a plan. Why are we so concerned?Asthma is a chronic (long-term) inflammatory condition of the airways. Inflammation and narrowing of the airways lead to respiratory symptoms such as wheezing, breathlessness, chest tightness and coughing. These symptoms can come and go, or persist.Over the past 15 years or so, national surveys in several countries show a pattern of worse symptoms and more attacks, regardless of whether asthma is mild, moderate or severe.In some people with asthma, the airways can become permanently narrowed from very early on. This can mean someone’s asthma doesn’t respond as well to treatment.In 2024, 478 Australians died from asthma. In 2023–2024 there were about 32,000 hospitalisations where asthma was the main cause. Some 90% of these hospitalisations were potentially preventable with better community care.In 2023–2024, Australia’s health system spent an estimated A$1.3 billion on asthma. Yet outcomes over the past decade – such as more people with good asthma control and with fewer attacks – have stalled or worsened. Much of this burden is preventable and a cure would eliminate the problem. A recent blueprint for asthma reform in Australia outlines the policy and practice changes that could help this happen. From improved symptoms to remissionIn about 20–30% of cases (usually children), asthma gets better by itself and goes into “spontaneous remission”. This is where symptoms reduce and airway tissue returns to normal. So, in principle, all asthma should be curable.People with severe disease who take certain biological asthma therapies that target inflammatory pathways can also experience what’s called sustained “on treatment” remission. This means excellent symptom control, no attacks, no need for reliever medications and optimised lung function. If asthma remission is sustained, treatment can be reduced but only under careful medical supervision.The more we learn about the underlying mechanisms of asthma – especially what happens in people in lasting spontaneous remission who no longer take medication – the closer a cure becomes.So what’s a cure, then?A cure should include:sustained elimination, that is, no symptoms over a long period and normal airway functionresolution (normalisation) of the underlying disease, which might include no sustained inflammation or narrowing of the airwaysresetting of the molecular processes that drive asthma. For instance, markers of inflammation would be similar to someone without asthma, or someone’s lung tissue no longer holds “molecular memories” of being permanently diseased.A cure could be due to a new type of medicine that “turns off” asthma or “resets” the underlying “molecular memory” processes that otherwise sustain disease. This means ongoing medication would no longer be needed.We’d also need to know asthma has been “cured” by testing for a specific biomarker or combination of biomarkers in the blood, airway tissue or exhaled air. These biomarkers could be specific molecules or physical characteristics, for instance.After three to five years, confirmed by tissue repair and biomarkers, we would have confidence the underlying mechanisms have truly been turned off and asthma has been cured.How could we get there?Documentation of spontaneous remissions and other evidence shows asthma is reversible.We also know which risk factors for asthma – such as family history, history of allergy, smoking or obesity, and exposure to poor air quality – interact and play out at the molecular level. These interactions amplify disease processes, make it harder for symptoms to resolve and mean airway tissue remains “hard-wired” in a diseased state.For example, all children get viral respiratory infections, but a combination of genetic risks and exposures cause some to acquire changes in the cells lining their airways that lead to persistent asthma.By combining these tiers of information with “machine learning” technologies (artificial intelligence) we could create “digital twins” of real patients. We could then learn more about the mechanisms behind their disease, and match them to computer-generated drugs. These so-called “in silico” drugs could then be tested in simulations, made, refined and developed.Current asthma medicines dampen the drivers of disease, especially some types of inflammation, and suppress symptoms. However, these future medicines would “correct and reprogram” diseased cells back to health.For this and other initiatives towards an asthma cure, we need to prioritise our research efforts, with the funding to match.Naming the ambition and potential to cure asthma marks an essential change in our thinking and expectations.Christine Jenkins receives funding from NHMRC and MRFF for research grants awarded, independent of the CURE Asthma initiative described in this article. The Future of Asthma Blueprint, referred to in this article, was helped by independent grants from AstraZeneca, Chiesi, GlaxosmithKline, Sanofi and Novartis who played no other part in the activities and generation of the blueprint.Gary Anderson receives funding from NHMRC and MRFF for research grants awarded, independent of the CURE Asthma initiative described in this article. He also receive NHMRC and MRFF funding for a clinical trial, a data integration project and a development grant broadly related to this article. In the past five years he has received honoraria for lectures and scientific committee from AstraZeneca, Chiesi and GlaxosmithKline. He is a cofounder of ARI-tx which is developing inhaled respiratory medicines.