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Percentage of participants have asthma exacerbations up to 2 years after decreasing controller medications

Thirty-two percent of participants from a retrospective analysis suffered an asthma exacerbation in the 2-year period following a step down process of controller medication, according to study results.

“The current study suggests that the asthma exacerbation risk after stepping down asthma medication is similar to previous reports despite differences in patient selection, study setting and length of follow-up,” Matthew A. Rank, MD, of the Division of Allergy, Asthma, and Clinical Immunology at the Mayo Clinic in Scottsdale, and colleagues wrote.

The researchers conducted a retrospective claims analysis of 26,292 individuals from the Optum Labs Data Warehouse using data from 2000 to 2012 to analyze the time to first asthma exacerbation after stepping down controller medication.

The researchers identified a step down event as a 50% or greater reduction in days-supplied of controller medications from one evaluation period to the next. Researchers followed each individual for 10 consecutive 4-month intervals – three prior to stepping down, one where the step down occurred, and six after the step down.

Of the 32% of the participants who suffered an asthma exacerbation during the subsequent 2 years, 7% had an ED visit or hospitalization for asthma.

Several variables correlated with a shortened time to asthma exacerbation. Participants aged 19 years and younger, of the female sex and of black race had an increased risk for a quicker asthma exacerbation (P < .001 for all).

The researchers do mention there are some limitations that suggest caution with interpreting study results.

“First, we did not include individuals who did not step down in our analysis; therefore, the 32% risk of an asthma exacerbation is an absolute risk not adjusted for baseline risk of those who had asthma exacerbations despite continuation of asthma controller medication,” the researchers wrote. “Finally, using observational data prevents collection of all desired variables, many of which may be important predictors of stability after asthma step down such as spirometry, sputum for eosinophils, exhaled nitric oxide, or other biomarkers.”

Disclosure: The researchers report no relevant financial disclosures.