The Asthma Controller Step-down Yardstick

Chipps, Bradley E.; Bacharier, Leonard B.; Murphy, Kevin R.; Lang, David M.; Farrar, Judith Rosen; Rank, Matthew A.; Oppenheimer, John; Zeiger, Robert S.

doi:10.1016/j.anai.2018.12.004

Cited by 13 publications

(14 citation statements)

References 154 publications

(243 reference statements)

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“…the tapering algorithm is not the subject of study per se) and results in a diverse selection of study-specific algorithms (19)(20)(21)(22)(23)(24)(25)(26), whose detail varies significantly between published studies. Current recommendations (4,27) do not provide guidance on the choice of OCS tapering protocol or otherwise how to taper. From a clinical perspective, the lack of asthma-specific guidelines on OCS tapering and the systematic screening of adverse events represents a key barrier to reducing OCS use (16).…”

Section: Introductionmentioning

confidence: 99%

Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study

Suehs

Menzies‐Gow

Price

et al. 2021

Am J Respir Crit Care Med

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The study facilitator (C.M.S.) designed the study, developed the protocol and data collection tools, classified hundreds of raw brainstorming statements, organized survey logistics, collected and analyzed the data, and wrote the report. The steering committee (A.M.-G., D.P., E.R.B., G.W.C., M.G., and A.B.) provided initial recommendations of experts invited to enroll in the study and provided guidance to C.M.S. on study design, data collection, survey logistics, data analysis, and report writing. Expert panel members who contributed complete questionnaires to the study are listed in the online supplement. All authors participated in the Funding: This study was funded by an unrestricted grant obtained through an investigatordriven submission to the AstraZeneca Cybergrant portal for educational programs. This research was conducted entirely independently of the funder, who had no role in the study design, data collection, analysis, or interpretation/write-up of the study report or manuscript. Medical writing support was funded via the unrestricted grant.

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Section: Introductionmentioning

confidence: 99%

Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study

Suehs

Menzies‐Gow

Price

et al. 2021

Am J Respir Crit Care Med

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“…Community pharmacists answered a shorter sixitem (one page) version of the survey. The questionnaires and interviews were first discussed with knowledgeable key informants (face validity) before drawing up a question guide which was piloted, developed, modified and informed by a review of the literature [9][10][11][12] (Supplementary Table 1). Respondents were able to review and change their answers.…”

Section: Data Collectionmentioning

confidence: 99%

<p>Qualitative Study of Practices and Challenges of Stepping Down Asthma Medication in Primary Care Across the UK</p>

Bloom¹,

Ramsey²,

Alter³

et al. 2020

JAA

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Background: Guidelines recommend that asthma treatment should be stepped down to the minimally effective dose that achieves symptom control to prevent medication side effects and reduce unnecessary costs. Little is known about the practice of stepping down and the challenges in primary care, where most asthma patients are managed. Objective: To explore views, experiences, barriers and ideas, of doctors, nurses and pharmacists working in primary care, related to step down of asthma medication. Methods: Primary care practitioners from across the UK participated in a survey and/or semi-structured interview. Questions explored four main areas: how asthma medication is reviewed, views on asthma guidelines, perceived barriers faced by healthcare workers and facilitators of stepping down. Qualitative content analysis enabled data coding of interview transcripts to identify major themes. Results: A total of 274 participants responded to the survey, 29 participated in an interview (12 doctors, 9 nurses, and 8 pharmacists), working in GP practices from across the UK. Nearly half of the survey participants infrequently step down asthma medication (doc-tors=42.7%, nurses=46.3%). Four major themes related to barriers to stepping down were (i) lack of awareness of the need to step down, (ii) inertia to step down, driven by low confidence in ability, fear of consequences, and concern for who is responsible for stepping down, (iii) self-efficacy of ability to step down, influenced by lack of clear, applied guidance and limited training, and (iv) feasibility of step down, driven by a lack of systematic acceptance of stepping down and time. Strategies proposed to reduce overtreatment included education and training, improved gathering of evidence and guidance, and integrating step down into routine asthma care. Conclusion: Failure to implement this guideline recommendation into everyday asthma management is influenced by several contributing factors. Future directions should include addressing evidence gaps, implementing clear and practical guidance, integration of stepdown assessment into the asthma review, and education of professionals and patients.

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“…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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The Asthma Controller Step-down Yardstick

Cited by 13 publications

References 154 publications

Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study

Expert Consensus on the Tapering of Oral Corticosteroids for the Treatment of Asthma. A Delphi Study

<p>Qualitative Study of Practices and Challenges of Stepping Down Asthma Medication in Primary Care Across the UK</p>

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

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