Predicting failure when asthma treatment reduction is being considered

Published online: October 24, 2018

The minimum controlling dose of treatment must be established in all asthma patients through a process of regular follow-up and staged dose reductions, because it allows for lower costs and fewer side effects compared with maintaining the current treatment level. However, despite all the foreseeable precautions, a reduction of therapy entails a nonnegligible risk of unstable asthma, emergency visits, and hospital admissions.

Dr Pérez de Llano and colleagues have recently reported in The Journal of Allergy and Clinical Immunology: In Practice a study designed to develop and externally validate a score to anticipate risk of asthma deterioration when stepping down asthma therapy in well-controlled asthma patients.

A medical-record documented postbronchodilator spirometry result of <70% forced expiratory volume in 1 second (FEV1)/forced vital capacity, current FEV1 < 80%, ≥1 severe exacerbation in the previous 12 months, and Asthma Control Test score (a questionnaire of symptoms) < 25 were independently associated with failure. The score ranges from 0 to 10, and a result <4.5 implies a low risk of asthma worsening (<20%), whereas a score >8 implies a high risk (>40%).

We have developed a readily usable tool composed of 4 items (current or historical evidence of bronchial obstruction, at least one severe exacerbation in the prior 12 months, and not fully controlled symptoms) to predict step-down failure in patients with asthma who are being considered for this strategy.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

18-00526, A simple score for future risk prediction in patients with controlled asthma who undergo a step-down guidelines-based strategy