A Simple Score for Future Risk Prediction in Patients with Controlled Asthma Who Undergo a Guidelines-Based Step-Down Strategy
Por:
Pérez de Llano L, García-Rivero JL, Urrutia I, Martínez-Moragón E, Ramos J, Cebollero P, Carballada F, Blanco M, Vennera MDC, Merino M, García Nr YT and Plaza V
Publicada:
1 abr 2019
Ahead of Print:
25 oct 2018
Categoría:
Immunology and allergy
Resumen:
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 (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 (<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. (C) 2018 American Academy of Allergy, Asthma & Immunology
Filiaciones:
Pérez de Llano L:
Pneumology Service. Hospital Lucus Augusti. Lugo
García-Rivero JL:
Pneumology Service.Hospital Comarcal de Laredo
Urrutia I:
Pneumology Service. Hospital de Galdakao
:
Pneumology Service. Hospital Universitario Doctor Peset
Ramos J:
Pneumology Service. Complejo Asistencial de Salamanca
Cebollero P:
Pneumology Service. Complejo Asistencial de Navarra
Carballada F:
Allergology Unit. Hospital Lucus Augusti. Lugo
Blanco M:
Pneumology Service CHUAC. A Coruña
Vennera MDC:
Servei de Pneumologia i Al·lèrgia Respiratòria. Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES)
Merino M:
Health Outcomes Research Department. Weber, Economía y Salud. Madrid
García Nr YT:
Servei de Pneumologia i Al·lèrgia Respiratòria. Hospital Clinic, Universitat de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES)
Plaza V:
Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau. Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
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