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. 2017 Apr;47(4):467-478.
doi: 10.1111/cea.12888. Epub 2017 Feb 13.

Assessment of biological, psychological and adherence factors in the prediction of step-down treatment for patients with well-controlled asthma

N Saito  1   2 , A Kamata  3 , M Itoga  1 , M Tamaki  4 , H Kayaba  1 , T Ritz  2
Affiliations

Assessment of biological, psychological and adherence factors in the prediction of step-down treatment for patients with well-controlled asthma

N Saito et al. Clin Exp Allergy. 2017 Apr.

Abstract

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.

Keywords: adherence; asthma; inhaled corticosteroids; psychosocial factors; step-down treatment; upper airway comorbidity.

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