TY - JOUR
T1 - A Simple Score for Future Risk Prediction in Patients with Controlled Asthma Who Undergo a Guidelines-Based Step-Down Strategy
AU - Pérez de Llano, Luis
AU - García-Rivero, Juan Luis
AU - Urrutia, Isabel
AU - Martínez-Moragón, Eva
AU - Ramos, Jacinto
AU - Cebollero, Pilar
AU - Carballada, Francisco
AU - Blanco-Aparicio, Marina
AU - Vennera, María del Carmen
AU - Merino, María
AU - Torralba-García, Yolanda
AU - Plaza, Vicente
N1 - Publisher Copyright:
© 2018 American Academy of Allergy, Asthma & Immunology
PY - 2019/4
Y1 - 2019/4
N2 - Background: The minimum controlling dose of treatment must be established in patients with asthma, but the outcome of step-down is unpredictable. Objective: To identify factors associated with risk of control loss when stepping down asthma treatment and to develop a score to predict this risk. Methods: A prospective, multicenter study including adults with well-controlled asthma was performed. Treatment was stepped up or stepped down over a 12-month period to maintain asthma control. We determined associations between clinical and functional variables and step-down failure. Finally, we derived a score to predict loss of control in 1 cohort and validated it in an independent cohort. Results: The derivation cohort consisted of 228 patients; 218 completed at least 1 step-down episode and a total of 495 step-down episodes were evaluated. A medical-record documented postbronchodilator spirometry result of <70% forced expiratory volume in 1 second (FEV 1 )/forced vital capacity (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.26-3.43), current FEV 1 < 80% (OR = 1.80; 95% CI: 1.03-3.14), ≥1 severe exacerbation in the previous 12 months (OR = 2.43; 95% CI: 1.48-4.01), and Asthma Control Test score < 25 (OR = 2.30; 95% CI: 1.35-3.92) were independently associated with failure. The score showed an area under the curve of 0.690 (95% CI: 0.633-0.747; P <.05) in the derivation cohort and 0.76 (95% CI: 0.643-0.882; P <.001) in a validation cohort of 114 patients. A score <4.5 implies a low risk of failure (<20%), whereas a score >8 implies a high risk (>40%). Conclusion: This score can facilitate the prediction of step-down failure before medication taper in patients with well-controlled asthma.
AB - Background: The minimum controlling dose of treatment must be established in patients with asthma, but the outcome of step-down is unpredictable. Objective: To identify factors associated with risk of control loss when stepping down asthma treatment and to develop a score to predict this risk. Methods: A prospective, multicenter study including adults with well-controlled asthma was performed. Treatment was stepped up or stepped down over a 12-month period to maintain asthma control. We determined associations between clinical and functional variables and step-down failure. Finally, we derived a score to predict loss of control in 1 cohort and validated it in an independent cohort. Results: The derivation cohort consisted of 228 patients; 218 completed at least 1 step-down episode and a total of 495 step-down episodes were evaluated. A medical-record documented postbronchodilator spirometry result of <70% forced expiratory volume in 1 second (FEV 1 )/forced vital capacity (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.26-3.43), current FEV 1 < 80% (OR = 1.80; 95% CI: 1.03-3.14), ≥1 severe exacerbation in the previous 12 months (OR = 2.43; 95% CI: 1.48-4.01), and Asthma Control Test score < 25 (OR = 2.30; 95% CI: 1.35-3.92) were independently associated with failure. The score showed an area under the curve of 0.690 (95% CI: 0.633-0.747; P <.05) in the derivation cohort and 0.76 (95% CI: 0.643-0.882; P <.001) in a validation cohort of 114 patients. A score <4.5 implies a low risk of failure (<20%), whereas a score >8 implies a high risk (>40%). Conclusion: This score can facilitate the prediction of step-down failure before medication taper in patients with well-controlled asthma.
KW - Asthma
KW - Asthma guidelines
KW - Asthma management
KW - Inhaled corticosteroids
KW - Step-down
UR - http://www.scopus.com/inward/record.url?scp=85057847753&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2018.10.017
DO - 10.1016/j.jaip.2018.10.017
M3 - Article
C2 - 30368006
AN - SCOPUS:85057847753
SN - 2213-2198
VL - 7
SP - 1214-1221.e3
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 4
ER -