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Assessment of biological, psychological and adherence factors in the prediction of step‐down treatment for patients with well‐controlled asthma
Author(s) -
Saito N.,
Kamata A.,
Itoga M.,
Tamaki M.,
Kayaba H.,
Ritz T.
Publication year - 2017
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.12888
Subject(s) - asthma , medicine , risk factor , odds ratio , inhaler , depression (economics) , anxiety , protective factor , psychiatry , economics , macroeconomics
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.