Factors that determine the loss of control when reducing therapy by steps in the treatment of moderate-severe asthma in standard clinical practice: A multicentre Spanish study

• Published in: Revista clínica espanõla (English edition) Vol. 220; no. 2; pp. 86 - 93
• Main Authors: Martínez-Moragón, E, Patricia, Prieto Montaño, Ángel, Ferrer Torres, José, Zapata Yebenes Juan, Teresa, Audicana Berasategui María, Marta, Frias Jiménez, Nieves, Hurtado de Mendoza Ruibio, Marta, Velasco Azagra, Antonio, Álvarez Fernández Jose, Estela, Gómez Nieves María, Diego, Aisa Carpio, David, De La Rosa Carrillo, Jordi, Juanola Pla, Alejandra, López Giraldo, Carlos, Martínez Rivera, Ester, Pinto Nogués, Francisco, Planas Coimerma, Karina, Portillo Carroz, Antoni, Riba Blanch, Dan, Sánchez Berenguer, Pere, Serra Mitjà, Lorena, Soto Retes, Ignacio, Ansotegui Zubeldia, Miguel, Herrerías Peña, Adolfo, Lahuerta Castro, Lidia, Alonso Gil, Teresa, Peña Miguel, Tahar, Ahmida, Isabel, Alvarado Izquierdo María, Aurelio, Arnedillo Muñoz, Diego, Gutiérrez Fernández, Luis, Fernández Pellon, Maria, Morchon Miguel Eva, Frederic, Tatay Soler, Alberto, Levy Naon, Pedro, Galindo Bonilla, Luis, Gil Muñoz Francisco, Patricia, Mata Calderón, Manuel, Entrenas Costa Luis, Marina, Blanco Aparicio, Manuel, García Pazos Jose, Francisco-Javier, González Barcala, Pilar, Iriarte Sotes, Fernando, Molina Nieto, Carracedo, Sevillano Martín, Julia, Tábara Rodríguez, Carlos, Sabadell Nieto, Gladis, Sabater Talaverano, Mar, Escribano Rodríguez M, Fernando, Florido López José, Ángeles, Lara Jiménez María, José, Rojas Vílchez María, Susana, Chic Palacín, Silvia, Dorronsoro Quintana, Eduardo, Figueroa de la Guardia, Joaquín, Cegoñino de Sus, Santonio, Compaired Villa Jose, Dolores, Soto Venegas Antonia, Begoña, Blanco Reinosa, Beatriz, Fernández Parra, Adolfo, Velez Ruiz de Lobera, Silvia, Lara Alcon, Francisco, Carballada González, Joaquín, Martín Lázaro, Noemí, Mengual Macenlle, Soledad, Alonso Viteri, Irina, Bobolea, Puerto, Cano Aguirre M Del, Remedios, Cardenas Contreras, Fernando, Carrillo Arias, Mercedes, Cimarra Álvarez, Belén, De Higes Martínez Eva, Andrés, García Romero de Tejada Jose, Eloina, González Mancebo, Emma, González Seco, Aythamy, Henríquez Santana, Lys, Herráez Herrera Pilar de, Pedro, Landete Rodríguez, Belén, López-Muñiz Ballesteros, Antonio, Moreno Fernández, Esther, Muñoz García, Fernando, Pedraza Serrano, Yesenia, Peña Acevedo Acevedo, Ángela, Ramos Pinedo, Mercedes, Rodríguez Rodríguez, Ana, Rosado Ingelmo, Antonio, Ruiz Peña, Jesús, Trujillo Trujillo María, Laura, Vázquez Fuertes, Alexandra, Yago Meniz, José, Alcázar Ramírez Alcázar Ramírez, Manuel, Barceló Muñoz José, Miguel, Bentabol Manzanares, Ezequiel, Ortega Sáenz de Tejada, Alicia, Padilla Galo, Manuel, Pérez Estrada Cornejo, Carmen, Soria Esojo, Francisco, Abellán Alemán Ángel, Consuelo, Alcalde Rumayor María, Tamara, Gutiérrez Urra
• Format: Journal Article
• Language: English; Spanish
• Published: 01-03-2020
• ISSN: 2254-8874
• DOI: 10.1016/j.rce.2019.05.004

BACKGROUNDAlthough the clinical practice guidelines recommend continuous adjustment of asthma treatment and reducing the maintenance drugs when achieving control (step-down), there are few studies of standard clinical practice aimed at collecting information on the factors that determine step-down failure. OBJECTIVETo determine the factors that determine step-down failure in standard clinical practice of patients with moderate-severe asthma controlled by a combination of inhaled glucocorticoids and long-acting beta agonists. METHODSA multicentre retrospective study included 374 patients with moderate-severe asthma controlled with inhaled glucocorticoids and long-acting beta agonists for whom the physician indicated a step-down in 2016. RESULTSThe step-down failed in 41.7% of the patients. The following factors were related to failure: greater patient age (P=.006), presence of at least 2 comorbidities (P=.016), greater severity level (severe persistent vs. moderate persistent) (P<.001), greater age at diagnosis (>40 years) (P=.045), the higher the therapeutic step before (P=.003) and after the change (P<.001), the shorter the time of improvement/control prior to the change (P=.019), lower FEV1 (P=.001) and a poorer Asthma Control Test score or Asthma Control Questionnaire score before the step-down (P<.001). The logistic regression analysis showed a higher probability of step-down failure in the more elderly patients (OR, 0.983; 95% CI 0.969-0.997) and those with severe asthma compared to those with moderate asthma (OR, 0.537; 95% CI 0.292-0.985), as well as an increased probability of success if the patients had the disease controlled for more than 6 months (OR, 2.253; 95% CI 1.235-4.112). CONCLUSIONIn standard clinical practice conditions, step-down fails in a high percentage of patients, and the suggestion is to indicate step-down when the patient has had more than 6 months of disease control.