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A Simple Score for Future Risk Prediction in Patients with Controlled Asthma Who Undergo a Guidelines-Based Step-Down Strategy

2018; Elsevier BV; Volume: 7; Issue: 4 Linguagem: Inglês

10.1016/j.jaip.2018.10.017

2213-2201

Luís Pérez de Llano, Juan Luis García‐Rivero, Isabel Urrutia, Eva Martínez‐Moragón, Jacinto Ramos, Pilar Cebollero, Francisco Carballada, Marina Blanco–Aparicio, María del Carmen Vennera, María Merino, Yolanda Torralba, Vicente Plaza,

Inhalation and Respiratory Drug Delivery

The minimum controlling dose of treatment must be established in patients with asthma, but the outcome of step-down is unpredictable.To identify factors associated with risk of control loss when stepping down asthma treatment and to develop a score to predict this risk.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.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 (FEV1)/forced vital capacity (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.26-3.43), current FEV1 < 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 ( 8 implies a high risk (>40%).This score can facilitate the prediction of step-down failure before medication taper in patients with well-controlled asthma.