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Start Over Author "Yebenes, Juan" Publisher elsevier espana
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2. 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.

Author

Martínez-Moragón E, Delgado J, Mogrovejo S, Fernández-Sánchez T, Jesús JL, Ángel MOM, Patricia PM, Miguel TT, Begoña CO, Ángel FT, Purificación GD, Wilfox JRT, Brian VA, José ZYJ, Teresa ABM, Marta FJ, Nieves HMR, Marta VA, Antonio ÁFJ, Sara AS, Rosa BGM, Estela GNM, Diego AC, Núria AS, Cristina BG, Astrid CL, David RC, Jordi JP, Alejandra LG, Olga LS, Carlos MR, Pilar MO, Xavier MG, Ester PN, Francisco PC, Karina PC, Antoni RB, Luisa ROM, Dan SB, Joan SB, Pere SM, Ana SS, Lorena SR, Joan VC, Xavier VG, Ignacio AZ, Ignacio AE, Miguel HP, Milagros IPM, Carmen JM, Adolfo LC, Amaia LL, Paula LL, Joaquina PP, Vanessa ZL, Lidia AG, Pablo GMJ, Marisa MD, Teresa PM, Tahar A, Isabel AIM, Michael AO, Aurelio AM, Ignacio GN, Diego GF, Antonio LC, Luis FP, Maria MME, Félix OP, Isabela R, Antonio RPJ, Dolores SSM, Frederic TS, Alberto LN, Pedro GB, Luis GMF, Patricia MC, Manuel ECL, Marina BA, Manuel GPJ, Vanessa GP, Francisco-Javier GB, Pilar IS, Jorge MRP, Fernando MN, Ramón NO, Carracedo SM, Juan SA, Julia TR, Santiago AE, Carlos SN, Gladis ST, Mar ERM, Fernando FLJ, Ángeles LJM, José RVM, Susana CP, Silvia DQ, Antonio NEJ, Eduardo FG, Belén HJ, Victoria MG, Lucía VV, Joaquín CS, Santonio CVJ, Alfonso ALJ, Eduardo AC, María CMJ, Dolores SVA, Patricia BM, Begoña BR, Beatriz FP, Domingo FG, Virginia SG, Adolfo VRL, Silvia LA, Francisco CG, Teresa GF, Joaquín ML, Noemí MM, Soledad AV, Darío AA, Irina B, Puerto CAMD, Remedios CC, Fernando CA, Mercedes CÁ, Belén HME, Magdalena DCR, Mar GCMD, Leticia GR, Andrés GRTJ, Eloina GM, Emma GS, Fernando GT, Aythamy HS, Lys HHP, Ruth HMM, Pedro LR, Belén LB, Ester MV, Beatriz MC, Antonio MF, Esther MG, Elena OC, Fernando PS, Yesenia PAA, Raquel PR, Natividad QR, Ángela RP, Beatriz RJ, Mercedes RR, Ana RI, Antonio RP, José SGM, Jesús TTM, Laura VF, Concepción VA, Alexandra YM, Ismael APGR, José ARAR, Manuel BMJ, Miguel BM, Gustavo LM, Ignacio GN, Francisco LL, Alfonso MP, Ezequiel OST, Alicia PG, Manuel PEC, Carmen SE, Francisco AAÁ, Consuelo ARM, Rubén AE, Roberto BM, Javier CLF, Tamara GU, Sonia HM, Alfredo RL, and Raquel DQ

Abstract

Background: Although 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., Objective: To 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., Methods: A 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., Results: The 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 FEV 1 (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)., Conclusion: In 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., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Published
2020
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