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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Inselman JW, Jeffery MM, Maddux JT, Lam RW, Shah ND, Rank MA, Ngufor CG. A prediction model for asthma exacerbations after stopping asthma biologics. Ann Allergy Asthma Immunol 2023; 130:305-311. [PMID: 36509405 PMCID: PMC9992017 DOI: 10.1016/j.anai.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Little is known regarding the prediction of the risks of asthma exacerbation after stopping asthma biologics. OBJECTIVE To develop and validate a predictive model for the risk of asthma exacerbations after stopping asthma biologics using machine learning models. METHODS We identified 3057 people with asthma who stopped asthma biologics in the OptumLabs Database Warehouse and considered a wide range of demographic and clinical risk factors to predict subsequent outcomes. The primary outcome used to assess success after stopping was having no exacerbations in the 6 months after stopping the biologic. Elastic-net logistic regression (GLMnet), random forest, and gradient boosting machine models were used with 10-fold cross-validation within a development (80%) cohort and validation cohort (20%). RESULTS The mean age of the total cohort was 47.1 (SD, 17.1) years, 1859 (60.8%) were women, 2261 (74.0%) were White, and 1475 (48.3%) were in the Southern region of the United States. The elastic-net logistic regression model yielded an area under the curve (AUC) of 0.75 (95% confidence interval [CI], 0.71-0.78) in the development and an AUC of 0.72 in the validation cohort. The random forest model yielded an AUC of 0.75 (95% CI, 0.68-0.79) in the development cohort and an AUC of 0.72 in the validation cohort. The gradient boosting machine model yielded an AUC of 0.76 (95% CI, 0.72-0.80) in the development cohort and an AUC of 0.74 in the validation cohort. CONCLUSION Outcomes after stopping asthma biologics can be predicted with moderate accuracy using machine learning methods.
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Affiliation(s)
- Jonathan W Inselman
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Molly M Jeffery
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Regina W Lam
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Nilay D Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; OptumLabs, Cambridge, Massachusetts
| | - Matthew A Rank
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona; Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Arizona.
| | - Che G Ngufor
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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Cazzola M, Matera MG, Rogliani P, Calzetta L, Ora J. Step-up and step-down approaches in the treatment of asthma. Expert Rev Respir Med 2021; 15:1159-1168. [PMID: 34032534 DOI: 10.1080/17476348.2021.1935245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Significant intraindividual and temporal variability in symptom control is a feature of asthma that requires careful monitoring and the need to periodically review and adjust therapy. Both NHLBI/NAEPP and GINA offer helpful algorithms for a stepping approach to asthma.Areas covered: The problems arisen in applying the stepwise approach to the treatment of asthma proposed by NHLBI/NAEPP and GINA algorithms and their possible alternatives.Expert opinion: The current therapeutic stepping approach to asthma, which takes into account lung function, symptoms and quality of life, is certainly useful, but it does not consider the underlying mechanisms. Furthermore, patient's overestimation or underestimation of the severity of the disease and differences in the opinions on the level of asthma control required between patients and physicians and also between physicians in both primary care and specialist settings are common and may negatively affect asthma control and future risks. A reassessment of the conventional stepping approach to management of asthma is now needed. A pragmatic approach that sets therapeutic goals for each individual and associates them with the treatable traits of asthma which, when therapeutically targeted, will in many cases help to achieve the goals, seems more reasonable than the present stepping approach.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.,Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy
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Öztürk BÖ, Sözener ZÇ, Aydin Ö, Mungan D. A step-down experience in asthma treatment: a retrospective cohort study. J Asthma 2021; 59:998-1004. [PMID: 33827371 DOI: 10.1080/02770903.2021.1895211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND According to recent guidelines; patients with controlled asthma who are stable for at least three months and don't have risk factor should be considered for step down. OBJECTIVE To evaluate our step down attempts and affecting factors. METHODS This study was a retrospective-cohort study of patients with asthma who were followed up in our clinic for at least one year. Sociodemographic, phenotypic, clinical features and number of step-down attempts were recorded from the files. Step down was tried in well controlled patients and considered as successful whether descending step was maintained or a lower step was reached until the last visit. RESULTS A total of 239 patients (196 F/43 M) with a mean age of 51.54 ± 15.29 years were included in the study. Step-down attempt was performed in 44.8% (n = 107) of the patients and % 74.8 (n = 80) of them were successful. Factors related to failure were lower level of education, allergic comorbidity (p = 0.04) and female gender (p = 0.04). Risk of failure was 3.45 and 1.84 times higher than university graduates in high school and primary school graduates, respectively. The probability of failure in step down was 3.38 times higher in patients with allergic comorbidity, and it was 3.92 times more likely in women than men. CONCLUSIONS Our results showed that the step down attempt could be performed in patients receiving treatment from all steps. In addition, treatment of allergic comorbidities and increased level of education, may make a step down attempt more successful.
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Affiliation(s)
- Betül Özdel Öztürk
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Çelebi Sözener
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Ömür Aydin
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Dilsad Mungan
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
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Pérez de Llano L, Blanco Cid N, Martin Robles I, Golpe R, Castro-Añon O, Dacal Rivas D. Regarding the role of F ENO in predicting failure after ICS reduction in mild-to-moderate asthma patients. Eur Respir J 2020; 56:56/2/2002375. [PMID: 32820023 DOI: 10.1183/13993003.02375-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Luis Pérez de Llano
- Pneumology Service, Hospital Lucus Augusti, EOXI Lugo, Cervo e Monforte, Lugo, Spain
| | - Nagore Blanco Cid
- Pneumology Service, Hospital Lucus Augusti, EOXI Lugo, Cervo e Monforte, Lugo, Spain
| | - Irene Martin Robles
- Pneumology Service, Hospital Lucus Augusti, EOXI Lugo, Cervo e Monforte, Lugo, Spain
| | - Rafael Golpe
- Pneumology Service, Hospital Lucus Augusti, EOXI Lugo, Cervo e Monforte, Lugo, Spain
| | - Olalla Castro-Añon
- Pneumology Service, Hospital Lucus Augusti, EOXI Lugo, Cervo e Monforte, Lugo, Spain
| | - David Dacal Rivas
- Pneumology Service, Hospital Lucus Augusti, EOXI Lugo, Cervo e Monforte, Lugo, Spain
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Wang K, Verbakel JY, Oke J, Fleming-Nouri A, Harada N, Atsuta R, Fujisawa T, Kawayama T, Inoue H, Lazarus S, Szefler S, Martinez FD, Shaw D, Pavord ID, Thomas M. Using fractional exhaled nitric oxide to guide step-down treatment decisions in asthma: practical considerations. Eur Respir J 2020; 56:56/2/2002809. [PMID: 32820024 DOI: 10.1183/13993003.02809-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Kay Wang
- Nuffield Dept of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Y Verbakel
- KU Leuven, Dept of Public Health and Primary Care, Leuven, Belgium
| | - Jason Oke
- Nuffield Dept of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Norihiro Harada
- Dept of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Ryo Atsuta
- Dept of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tomoyuki Fujisawa
- Second Division Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine, Kurume, Japan
| | - Hiromasa Inoue
- Dept of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Stephen Lazarus
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Stanley Szefler
- Children's Hospital Colorado, The Breathing Institute, Dept of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Dominick Shaw
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Ian D Pavord
- Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Mike Thomas
- Primary Care, Population Sciences and Medical Education (PPM), University of Southampton, Southampton, UK
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Martínez-Moragón E, Delgado J, Mogrovejo S, Fernández-Sánchez T, López JJ, Orenes MÁM, Montaño PP, Toro MT, Oliver BC, Torres ÁF, Delgado PG, Rodríguez TWJ, Auli BV, Yebenes JJZ, Berasategui MTA, Jiménez MF, Ruibio NHDM, Azagra MV, Fernández JAÁ, Sainz SA, González RMB, Nieves MEG, Carpio DA, Sellés NA, García CB, Lessmann AC, Carrillo DDLR, Pla JJ, Giraldo AL, Sánchez OL, Rivera CM, Olondris PM, Gall XM, Nogués EP, Coimerma FP, Carroz KP, Blanch AR, Ortún MLR, Berenguer DS, Batlles JS, Mitjà PS, Sagardía AS, Retes LS, Combas JV, Giralte XV, Zubeldia IA, Ercoreca IA, Peña MH, Pascual MMI, Michelena CJ, Castro AL, Legarreta AL, Llorente PL, Prieto JP, Lorenzo VZ, Gil LA, Muñoz JPG, Durantez MM, Miguel TP, Ahmida T, Izquierdo MIA, Olbah MA, Muñoz AA, Núñez IG, Fernández DG, Camacho AL, Pellon LF, Miguel EMM, Portal FO, Raducan I, Prats JAR, Segarra MDS, Soler FT, Naon AL, Bonilla PG, Muñoz FLG, Calderón PM, Costa LME, Aparicio MB, Pazos JMG, Paz VG, Barcala FJG, Sotes PI, Rodríguez PJM, Nieto FM, Orjales RN, Martín CS, Antelo JS, Rodríguez JT, Español SA, Nieto CS, Talaverano GS, Rodríguez MME, López JFF, Jiménez MÁL, Vílchez MJR, Palacín SC, Quintana SD, Echeverria JAN, Guardia EFDL, Jara BH, García VM, Vazquez LV, De Sus JC, Santonio J, López JAA, Campillo EA, Molina CVJMC, Venegas ADS, Martínez PB, Reinosa BB, Parra BF, García DF, Gutiérrez VS, Lobera AVRD, Alcon SL, González FC, Fernández TG, Lázaro JM, Macenlle NM, Viteri SA, Amerigo DA, Bobolea I, Aguirre MDPC, Contreras RC, Arias FC, Álvarez MC, Martínez EBDH, Campos RMD, Cano MDMG, Rodríguez LG, Tejada JAGRD, Mancebo EG, Seco EG, Torralba FG, Santana AH, Herrera PDLH, Mosquete MRH, Rodríguez PL, Ballesteros BLM, Vicente EM, Chacón BM, Fernández AM, García EM, Castillejo EO, Serrano FP, Acevedo YPA, Rojo RP, Ruiz-Rico NQ, Pinedo ÁR, Jiménez BR, Rodríguez MR, Ingelmo AR, Peña AR, González MJS, Trujillo MJT, Fuertes LV, Albelda CV, Meniz AY, Grovas RIAP, Ramírez JARA, Muñoz JMB, Manzanares MB, Martínez GDL, Núñez IG, Luna FLD, Paez AM, Tejada EOSD, Galo AP, Cornejo MPE, Esojo CS, Alemán ÁFA, Rumayor MCA, Espinosa RA, Mora RB, Lancharro FJC, Urra TG, Martín SH, Lizaldre AR, Quintas RD. Factors that determine the loss of control when reducing therapy by steps in the treatment of moderate-severe asthma in standard clinical practice: A multicentre Spanish study. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marín Romero S, Jara Palomares L. The dilemma of reducing treatment for patients with moderate-severe controlled asthma. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schatz M, Sicherer SH, Khan DA, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2019 Highlights. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:912-936. [PMID: 31980411 DOI: 10.1016/j.jaip.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
This article provides highlights of the clinically impactful original studies and reviews published in The Journal of Allergy and Clinical Immunology: In Practice in 2019 on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, food allergy, immunodeficiency, immunotherapy, rhinitis/sinusitis, and urticaria/angioedema/mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We designed this review to help readers consolidate and use this extensive and practical knowledge for the benefit of their patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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The dilemma of reducing treatment for patients with moderate-severe controlled asthma. Rev Clin Esp 2019; 220:117-118. [PMID: 31585668 DOI: 10.1016/j.rce.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022]
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Martínez-Moragón E, Delgado J, Mogrovejo S, Fernández-Sánchez T, Jesús JL, Ángel MOM, Patricia PM, Miguel TT, Begoña CO, Ángel FT, Purificación GD, Wilfox JRT, Brian VA, José ZYJ, Teresa ABM, Marta FJ, Nieves HDMR, Marta VA, Antonio ÁFJ, Sara AS, Rosa BGM, Estela GNM, Diego AC, Núria AS, Cristina BG, Astrid CL, David DLRC, Jordi JP, Alejandra LG, Olga LS, Carlos MR, Pilar MO, Xavier MG, Ester PN, Francisco PC, Karina PC, Antoni RB, Luisa ROM, Dan SB, Joan SB, Pere SM, Ana SS, Lorena SR, Joan VC, Xavier VG, Ignacio AZ, Ignacio AE, Miguel HP, Milagros IPM, Carmen JM, Adolfo LC, Amaia LL, Paula LL, Joaquina PP, Vanessa ZL, Lidia AG, Pablo GMJ, Marisa MD, Teresa PM, Tahar A, Isabel AIM, Michael AO, Aurelio AM, Ignacio GN, Diego GF, Antonio LC, Luis FP, Maria MME, Félix OP, Isabela R, Antonio RPJ, Dolores SSM, Frederic TS, Alberto LN, Pedro GB, Luis GMF, Patricia MC, Manuel ECL, Marina BA, Manuel GPJ, Vanessa GP, Francisco-Javier GB, Pilar IS, Jorge MRP, Fernando MN, Ramón NO, Carracedo SM, Juan SA, Julia TR, Santiago AE, Carlos SN, Gladis ST, Mar ERM, Fernando FLJ, Ángeles LJM, José RVM, Susana CP, Silvia DQ, Antonio NEJ, Eduardo FDLG, Belén HJ, Victoria MG, Lucía VV, Joaquín CDS, Santonio CVJ, Alfonso ALJ, Eduardo AC, María CMJ, Dolores SVA, Patricia BM, Begoña BR, Beatriz FP, Domingo FG, Virginia SG, Adolfo VRDL, Silvia LA, Francisco CG, Teresa GF, Joaquín ML, Noemí MM, Soledad AV, Darío AA, Irina B, Puerto CAMD, Remedios CC, Fernando CA, Mercedes CÁ, Belén DHME, Magdalena DCR, Mar GCMD, Leticia GR, Andrés GRDTJ, Eloina GM, Emma GS, Fernando GT, Aythamy HS, Lys HHPD, Ruth HMM, Pedro LR, Belén LMB, Ester MV, Beatriz MC, Antonio MF, Esther MG, Elena OC, Fernando PS, Yesenia PAA, Raquel PR, Natividad QRR, Ángela RP, Beatriz RJ, Mercedes RR, Ana RI, Antonio RP, José SGM, Jesús TTM, Laura VF, Concepción VA, Alexandra YM, Ismael APGR, José ARAR, Manuel BMJ, Miguel BM, Gustavo DLM, Ignacio GN, Francisco LDL, Alfonso MP, Ezequiel OSDT, Alicia PG, Manuel PEC, Carmen SE, Francisco AAÁ, Consuelo ARM, Rubén AE, Roberto BM, Javier CLF, Tamara GU, Sonia HM, Alfredo RL, Raquel DQ. Factors that determine the loss of control when reducing therapy by steps in the treatment of moderate-severe asthma in standard clinical practice: A multicentre Spanish study. Rev Clin Esp 2019; 220:86-93. [PMID: 31350049 DOI: 10.1016/j.rce.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although the clinical practice guidelines recommend continuous adjustment of asthma treatment and reducing the maintenance drugs when achieving control (step-down), there are few studies of standard clinical practice aimed at collecting information on the factors that determine step-down failure. OBJECTIVE To determine the factors that determine step-down failure in standard clinical practice of patients with moderate-severe asthma controlled by a combination of inhaled glucocorticoids and long-acting beta agonists. METHODS A multicentre retrospective study included 374 patients with moderate-severe asthma controlled with inhaled glucocorticoids and long-acting beta agonists for whom the physician indicated a step-down in 2016. RESULTS The step-down failed in 41.7% of the patients. The following factors were related to failure: greater patient age (P=.006), presence of at least 2 comorbidities (P=.016), greater severity level (severe persistent vs. moderate persistent) (P<.001), greater age at diagnosis (>40 years) (P=.045), the higher the therapeutic step before (P=.003) and after the change (P<.001), the shorter the time of improvement/control prior to the change (P=.019), lower FEV1 (P=.001) and a poorer Asthma Control Test score or Asthma Control Questionnaire score before the step-down (P<.001). The logistic regression analysis showed a higher probability of step-down failure in the more elderly patients (OR, 0.983; 95% CI 0.969-0.997) and those with severe asthma compared to those with moderate asthma (OR, 0.537; 95% CI 0.292-0.985), as well as an increased probability of success if the patients had the disease controlled for more than 6 months (OR, 2.253; 95% CI 1.235-4.112). CONCLUSION In standard clinical practice conditions, step-down fails in a high percentage of patients, and the suggestion is to indicate step-down when the patient has had more than 6 months of disease control.
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Affiliation(s)
| | - J Delgado
- Unidad de Gestión Clínica de Alergología, Hospital Virgen Macarena, Sevilla, España
| | - S Mogrovejo
- Neumología, Hospital Universitario Dr. Peset, Valencia, España
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