Assessment of biological, psychological and adherence factors in the prediction of step‐down treatment for patients with well‐controlled asthma. Issue 4 (13th February 2017)

• Record Type: Journal Article
• Authors: Saito, N.; Kamata, A.; Itoga, M.; Tamaki, M.; Kayaba, H.; Ritz, T.
• Is Part Of: Clinical & experimental allergy. Volume 47:Issue 4(2017)
• Page Start: 467
• Page End: 478
• Publication Date: 2017-02-13
• Subjects: adherence -- asthma -- inhaled corticosteroids -- psychosocial factors -- step‐down treatment -- upper airway comorbidity; Allergy -- Periodicals; Immunology -- Periodicals; 616.97
• DOI: 10.1111/cea.12888
• Languages: English
• ISSNs: 0954-7894

Abstract

Summary: Background and Objective: Inhaled corticosteroids (ICS) and inhaled corticosteroids combined with long‐acting beta2‐agonist (ICS/LABA) are standard treatments for asthma. However, factors that might help reduce medication in well‐controlled asthma are unknown. We classified problems of asthma patients into biological, psychological and adherence factors, and investigated factors associated with the indication and failure of a medication step‐down treatment. Methods: Two hundred twenty two well‐controlled asthma patients receiving ICS or ICS/LABA were assessed for physical and psychiatric problems and followed up for one year from adjustment of their treatment step. Factor B was defined as a presence of chronic upper airway complications. Factor P was defined as presence of psychiatric complications such as sleep disorder, depression, anxiety and somatoform disorders. Factor A was defined as poor adherence to ICS or ICS/LABA inhaler of 75% or less. Success in step‐down treatment was defined as maintenance of well‐controlled status for over one year after step‐down. Results: Factor B was the most important single negative predictive factor for indication for step‐down treatment (Odds ratio; 0.19). Factor A increased the risk of failure to maintain step‐down treatment most significantly by 23‐fold, and factor B increased it by 11‐fold. The combination of factors B and A increased failure by 24‐fold, factors P and A by 21‐fold, all three factors by 36‐fold. Factor P only interacted with the other factors to reduce chances of stepping down, but did not constitute a problem factor when present alone. Conclusion and Clinical Relevance: The evaluation of biological, psychological and adherence problems may lead to a more proactive and targeted approach to step‐down treatment for patients with well‐controlled asthma.