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Course of asthma patients after withdrawal of inhaled corticosteroids

Published online; October 10, 2020

In clinical guidelines, inhaled corticosteroids (ICS) are recommended in all adult patients with persistent asthma to reduce airway inflammation. However, patients with mild asthma have difficulties in maintaining ICS for relatively mild symptom, and are concerned about side effects and costs, which lead to withdrawal.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Han et al investigated the real-world outcomes of acute exacerbation events associated with withdrawal of ICS in 145,551 patients using the Korean National Health Insurance database. The authors compared patients who received ICS consistently (maintenance group) with patients who had no ICS prescription for more than 6 months (withdrawal group), and evaluated exacerbations leading to prescription of additional oral or intravenous steroid, and emergency department (ED) visit or hospitalization.

The researchers identified 132,175 patients who maintained ICS and 13,336 patients who withdrew ICS for more than 6 months. Only 71 patients (0.5%) in the withdrawal group experienced exacerbation leading to an ED visit or hospitalization, which means most patients with asthma did not experience exacerbation events leading to hospitalization even after ICS withdrawal in real-life practice. ICS was restarted within 1 year for 33.6% of the withdrawal group, and 90% of those patients restarted ICS within 158 days. More than 1/3 of patients who withdrew ICS eventually reinitiated ICS, which emphasizes the value of maintenance of ICS. However, some patients did not reinitiate ICS use for a substantial period after withdrawal.

The authors concluded that ICS withdrawal appeared to confer relatively minimal harm; some asthmatics could be without ICS, and exacerbation leading to hospitalization was not common. Therefore, ICS cessation could be considered cautiously with physician’s consultation in patients who are well-controlled and have difficulties in maintaining ICS.

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

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