Step-Down Therapy for Asthma Well Controlled on Inhaled Corticosteroid and Long-Acting Beta-Agonist: A Randomized Clinical Trial

Rogers, Linda; Sugar, Elizabeth A.; Blake, Kathryn; Castro, Mario; DiMango, Emily; Hanania, Nicola A.; Happel, Kyle I.; Peters, Stephen P.; Reibman, Joan; Saams, J.N.; Teague, W. Gerald; Wise, Robert A.; Holbrook, Janet T.

doi:10.1016/j.jaip.2017.07.030

Cited by 22 publications

(18 citation statements)

References 33 publications

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“…In the past, the Food and Drug Administration (FDA) has supported the strategy of LABA discontinuation based on concerns about potential adverse effects of LABA. 33 Whether regular treatment with a LABA, even in combination with ICS, could predispose patients to untoward outcomes, including asthma-related morbidity and mortality, was an area of controversy. The outcomes of several recent large clinical trials and systematic reviews demonstrated that the risk of serious asthma-related adverse events with ICS/LABA was comparable to that for ICS monotherapy, [34][35][36][37][38][39][40] and as a result in December 2017 the FDA removed the boxed warning about asthma-related death from the drug labels of medicines containing the combination.…”

Section: Patients Using Low-dose Ics/labamentioning

confidence: 99%

The Asthma Controller Step-down Yardstick

Chipps

Bacharier

Murphy

et al. 2019

Annals of Allergy, Asthma & Immunology

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Asthma guidelines recommend a control-based approach to disease management in which the assessment of impairment and risk is linked to step-based therapy. Using this model, controller treatment is adjusteddupward or downwarddaccording to a patient's level of asthma control over time. Strategies for stepping up controller therapy are well described, and the adult and pediatric Asthma Yardsticks provide operational recommendations based on patient profiles. Strategies for stepping down controller treatment are less clear, although stepping down to the minimum effective therapy is important and should be considered when a patient's asthma has been well controlled for an adequate period as defined by risk and impairment. This Yardstick presents recommendations for when and how to step down asthma controller therapy according to guideline-defined control levels. The objective is to provide clinicians who treat patients with asthma with a practical and clinically relevant framework for implementing a step-down in controller therapy.

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Section: Patients Using Low-dose Ics/labamentioning

confidence: 99%

The Asthma Controller Step-down Yardstick

Chipps

Bacharier

Murphy

et al. 2019

Annals of Allergy, Asthma & Immunology

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“…Most previous studies have comprehensively described the pulmonary function and asthma symptoms after withdrawal of an ICS 2‐11 . Withdrawal of an ICS in adults and adolescents with controlled mild persistent asthma increased the risk of asthma exacerbations and the deterioration of FEV 1 (decline by 180 ml) and PEF (decline by 13 to 28 L/min) 8,10,21 .…”

Section: Discussionmentioning

confidence: 99%

“…The cornerstone of treatment for persistent asthma is the stepwise adjustment of medication depending on the extent of asthma control 1 . Many studies 2‐5 and review articles 6,7 reported change of lung function and asthma control after withdrawal of inhaled corticosteroids (ICSs), as stepping down from step‐2 treatment of adults or/and children with stable and mild asthma 8‐12 . However, there is little information on pulmonary function and asthma control after the withdrawal of a leukotriene receptor antagonist (LTRA) in children who have well‐controlled mild persistent asthma 13 .…”

Section: Introductionmentioning

confidence: 99%

Airway mechanics after withdrawal of a leukotriene receptor antagonist in children with mild persistent asthma: Double‐blind, randomized, cross‐over study

Kim

Lee

Shin

et al. 2020

Pediatric Pulmonology

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Background To determine the response of airway mechanics and the changes in asthma symptoms to stepping down of leukotriene receptor antagonist (LTRA) therapy. Methods Thirty children (mean age: 7.1 years) with mild, well‐controlled, and persistent asthma who took LTRA as maintenance treatment were randomized into a double‐blind, placebo‐controlled, cross‐over study. Each group received an LTRA (montelukast) or placebo daily for 2 weeks, followed by a 1‐week washout period, and then the alternate treatment for 2 weeks. Spirometry and impulse oscillation system (IOS) measurements before and after four puffs of salbutamol inhalation, fractional exhaled nitric oxide (FeNO), and the childhood asthma control test (C‐ACT) were evaluated at baseline, the end of placebo treatment, and the end of LTRA treatment. Results Changes of FEV1/FVC (p = .113) and FEV1 (p = .109) from baseline to posttreatment did not differ significantly between the placebo and montelukast groups. In the placebo group, prebronchodilator (pre‐) FEV1/FVC was decreased (83% vs. 86%) and bronchodilator response (BDR) in FEV1 was diminished (10.7% vs. 6.4%) at posttreatment compared with baseline. However, the montelukast group had no significant changes in pre‐FEV1/FVC (p = .865) and BDR in FEV1 (p = .461). In addition, compared with the montelukast group, the placebo group showed no significant changes in Rrs5 (total airway resistance), Rrs5–20 (peripheral airway resistance), FeNO, and symptoms by the C‐ACT. Conclusion In children with well‐controlled mild persistent asthma, changes in spirometry, IOS, FeNO, and C‐ACT results did not differ between the placebo and montelukast groups within 2 weeks.

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“…However, stopping LABA was associated with lower lung function and more hospitalizations; and decreasing the ICS dose was inferior to maintaining a stable dose of ICS-LABA. 274 If treatment is stepped down too far or too quickly, exacerbation risk may increase even if symptoms remain reasonably controlled 275 (Evidence B). Complete cessation of ICS is associated with a significant risk of exacerbations 276 (Evidence A).…”

Section: How To Step Treatment Downmentioning

confidence: 99%

Epidemiología del asma en adultos. Una visión introspectiva

Parisi

Zunino

Heras

et al. 2021

RAM

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Antecedentes: El asma es una enfermedad crónica de gran impacto en la salud pública y en la calidad de vida de los pacientes. En Latinoamérica existen escasos estudios epidemiológicosObjetivo: Describir la prevalencia del asma y las características clínico-demográficas en una población adulta de un sistema de salud privado de la ciudad de Buenos Aires.Métodos: Estudio de corte transversal de adultos afiliados al programa médico de un sistema de salud privado de Buenos Aires, entre el 1 de enero de 2017 y 1 de enero de 2018, con diagnóstico médico de asma. Resultados: La prevalencia de asma en pacientes adultos de un sistema de salud prepago en la ciudad de Buenos Aires fue de 6 % (n = 66, IC 95 % = 5-7) y de asma grave de 5 % (n = 3 IC 95 % = 1-13) La mayoría de los pacientes presentaron asma intermitente y leve. Conclusión: El estudio aporta nuevos datos sobre la epidemiología del asma en la región.

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Step-Down Therapy for Asthma Well Controlled on Inhaled Corticosteroid and Long-Acting Beta-Agonist: A Randomized Clinical Trial

Cited by 22 publications

References 33 publications

The Asthma Controller Step-down Yardstick

The Asthma Controller Step-down Yardstick

Airway mechanics after withdrawal of a leukotriene receptor antagonist in children with mild persistent asthma: Double‐blind, randomized, cross‐over study

Epidemiología del asma en adultos. Una visión introspectiva

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