Stepping down asthma treatment

Rogers, Linda; Reibman, Joan

doi:10.1097/mcp.0b013e32834db017

Cited by 21 publications

(21 citation statements)

References 52 publications

(53 reference statements)

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“…Longer-term control of airway inflammation in asthma is usually achieved using inhaled corticosteroids (ICS). Significantly, LABAs in combination with ICS, currently play an important role in the management of chronic persistent asthma 21. Both types of β2-agonists, as well as the more recently introduced ultra-LABAs, are generally considered to have good safety profiles, and these, as well as the cost-effectiveness of bronchodilator therapies, have been covered extensively in a recent review 1…”

Section: β2-adrenoceptor Agonists and Therapy Of Respiratory Airway Dmentioning

confidence: 99%

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Can the anti-inflammatory activities of β2-agonists be harnessed in the clinical setting?

Theron

Steel

Tintinger³

et al. 2013

DDDT

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Beta2-adrenoreceptor agonists (β2-agonists) are primarily bronchodilators, targeting airway smooth muscle and providing critical symptomatic relief in conditions such as bronchial asthma and chronic obstructive pulmonary disease. These agents also possess broad-spectrum, secondary, anti-inflammatory properties. These are mediated largely, though not exclusively, via interactions with adenylyl cyclase-coupled β2-adrenoreceptors on a range of immune and inflammatory cells involved in the immunopathogenesis of acute and chronic inflammatory disorders of the airways. The clinical relevance of the anti-inflammatory actions of β2-agonists, although often effective in the experimental setting, remains contentious. The primary objectives of the current review are: firstly, to assess the mechanisms, both molecular and cell-associated, that may limit the anti-inflammatory efficacy of β2-agonists; secondly, to evaluate pharmacological strategies, several of which are recent and innovative, that may overcome these limitations. These are preceded by a consideration of the various types of β2-agonists, their clinical applications, and spectrum of anti-inflammatory activities, particularly those involving adenosine 3′,5′-cyclic adenosine monophosphate-activated protein kinase-mediated clearance of cytosolic calcium, and altered gene expression in immune and inflammatory cells.

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Section: β2-adrenoceptor Agonists and Therapy Of Respiratory Airway Dmentioning

confidence: 99%

“…This is consistent with the well-documented anti-inflammatory interactions of combinations of LABAs and ICS, as discussed later in this review. Current guidelines for asthma therapy incorporate ICS/LABA combinations for patients not controlled on low doses of ICS 21,22…”

Section: β2-adrenoceptor Agonists and Therapy Of Respiratory Airway Dmentioning

confidence: 99%

Can the anti-inflammatory activities of β2-agonists be harnessed in the clinical setting?

Theron

Steel

Tintinger³

et al. 2013

DDDT

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“…Hasta el momento no existen guías ni consenso de cómo descender en la terapia antiasmática al lograr el control del asma. Algunas recomendaciones de expertos sugieren realizar el descenso de un 25-50% de la dosis de CSI cada 1 a 3 meses, hasta llegar a una dosis media o baja (34).…”

Section: ¿Cómo Ajustar La Terapia Antiasmática?unclassified

Asma Severa en Adultos: Enfoque Diagnóstico Y Tratamiento

Barría

Holguin

Wenzel

2015

Revista Médica Clínica Las Condes

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RESUMENEl asma es una enfermedad frecuente de fisiopatología compleja. El asma severa constituye aproximadamente el 5% de la población de asmáticos, sin embargo representa un desafío clínico y una carga sanitaria importante. Estudios recientes demuestran la existencia de fenotipos en todo el espectro de gravedad. La eosinofilia en esputo y sangre ha demostrado utilidad como marcador de inflamación Th-2 y de respuesta clínica a esteroides, sin embargo aún no existe mucho conocimiento sobre el asma no-eosinofílica. Los tratamientos actuales en asma se enfocan a estrategias de terapia escalonada según severidad, pero en pacientes con asma severa se requiere también del manejo multidisciplinario de las comorbilidades y la determinación del fenotipo, para aplicar terapias más especificas. El desarrollo acelerado de nuevos tratamientos en asma severa como consecuencia del mejor conocimiento de los distintos fenotipos ha ampliado el arsenal terapéutico para un enfrentamiento personalizado y específico en los pacientes con asma severa.Palabras clave: Asma severa, definición, fenotipos, manejo del asma. SUMMARYAsthma is a common disease of complex pathophysiology. Severe asthma accounts about 5% of asthma population, however represents a clinical challenge and a significant health burden. Recent studies show the existence of phenotypes through all the spectrum of severity. Eosinophilia in blood and sputum has proven as a useful marker of Th-2 inflammation and clinical steroid response, however there is still little knowledge about non-eosinophilic asthma. Current treatments for asthma are focused on step-up approaches according to severity, but severe asthma patients also require multidisciplinary management of comorbidities and phenotyping to apply more specific therapies. The fast development of new treatments in severe asthma as a result of better understanding of different phenotypes has broadened the therapeutic arsenal for a personalized and targeted management in severe asthma patients.

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“…For patients whose asthma is well-controlled, asthma management guidelines recommend gradually stepping down therapy to identify the lowest dose needed to maintain asthma control [1][2][3]. While the guidelines concur on the schedule of step-down (every 3 months), there is little published evidence regarding outcomes after stepping down therapy [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Inhaled Corticosteroid Therapy Step-Down and Dosing Regimen on Measures of Asthma Control

et al. 2013

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Background: Asthma guidelines recommend stepping down therapy to the lowest dose that maintains asthma control. Objective: We sought to evaluate the effect of dosing frequency and baseline patient and treatment-related factors on database markers of asthma control after inhaled corticosteroid (ICS) dose step-down. Methods: This retrospective observational study evaluated primary care patients (4-80 years old) with asthma prescribed twice-daily (BD) ICS (n=26,834) or ICS/long-acting β-agonist (LABA; n=20,814) for ≥ 1 year before ≥ 50% step-down in ICS dose, when they were switched to once-daily (QD) or remained on BD therapy. Study endpoints included exacerbations (oral corticosteroid prescription, unscheduled asthma-related hospital attendance, or general practice consultation for lower respiratory tract infection) and medication adherence. Results: Significant improvements in most endpoints were recorded during the year after step-down, as compared with the prior year (baseline). The proportion of patients with no exacerbation during the baseline year vs. the year after step-down was as follows (p<0.001 for all comparisons): QD ICS cohort (73% baseline vs. 81% after step-down); BD ICS cohort (67% vs. 77%); QD ICS/LABA cohort (60% vs. 64%); BD ICS/LABA cohort (55% vs. 65%). Adherence improved significantly after step-down for all cohorts, most markedly for QD cohorts; and the average daily ICS dose as consumed by patients was higher for all but the QD ICS/LABA cohort despite the reduction in prescribed dose. Factors predicting loss of asthma control after step-down for patients controlled at baseline in either or both ICS and ICS/LABA populations included obesity, smoking, comorbid rhinitis, comorbid gastroesophageal reflux disease, and, during the baseline year, ≥ 7 short-acting β-agonist prescriptions, mean consumed ICS dose of ≥ 800 µg/day, and ≥ 4 primary care consultations. Conclusion: Stepping down therapy is a valid management option and may improve asthma-related outcomes. Some improvements may result from increased adherence, particularly among patients switched to QD therapy.

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Stepping down asthma treatment

Cited by 21 publications

References 52 publications

Can the anti-inflammatory activities of β2-agonists be harnessed in the clinical setting?

Can the anti-inflammatory activities of β2-agonists be harnessed in the clinical setting?

Asma Severa en Adultos: Enfoque Diagnóstico Y Tratamiento

Effect of Inhaled Corticosteroid Therapy Step-Down and Dosing Regimen on Measures of Asthma Control

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Stepping down asthma treatment

Cited by 21 publications

References 52 publications

Can the anti-inflammatory activities of &beta;2-agonists be harnessed in the clinical setting?

Can the anti-inflammatory activities of &beta;2-agonists be harnessed in the clinical setting?

Asma Severa en Adultos: Enfoque Diagnóstico Y Tratamiento

Effect of Inhaled Corticosteroid Therapy Step-Down and Dosing Regimen on Measures of Asthma Control

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Can the anti-inflammatory activities of β2-agonists be harnessed in the clinical setting?

Can the anti-inflammatory activities of β2-agonists be harnessed in the clinical setting?