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Outcomes of stepping down asthma medications in a guideline-based pediatric asthma management program
Matthew A Rank1, Megan E Branda, Deborah B McWilliams
1Division of Allergy, Asthma, and Immunology, Mayo Clinic, Scottsdale, AZ 85259, USA. rank.matthew@mayo.edu
Insights
Stepping down asthma medications in children within a management program is often successful, especially outside of fall. Guideline eligibility also predicts success.
Area of Science:
- Pediatric pulmonology
- Asthma management
- Clinical outcomes research
Background:
- Outcomes of stepping down asthma medications in pediatric asthma management programs are not well-established.
- Understanding medication step-down success is crucial for optimizing treatment and reducing side effects.
Purpose of the Study:
- To investigate the outcomes of stepping down asthma medications in a pediatric asthma management program.
- To identify factors predicting successful medication step-down in children with asthma.
Main Methods:
- Retrospective study of 5- to 18-year-old children with asthma in a US-based integrated primary care practice (2009-2011).
- Assessed guideline eligibility for medication step-down, attempted step-downs, and success rates.
- Utilized descriptive statistics and univariate/multivariate analyses to identify predictors of successful step-down.
Main Results:
- 55.3% of children had guideline-eligible opportunities to step down medications; only 33.7% of these had an attempt.
- Overall, 34.8% of children attempted a step-down at least once.
- 71.6% of attempted step-downs were successful; stepping down outside of fall (OR=3.81) and guideline eligibility (OR=2.51, univariate) predicted success.
Conclusions:
- Stepping down asthma medication based on National Asthma Education and Prevention Program guidelines is frequently successful in children.
- Timing of step-down attempts (avoiding fall) and guideline eligibility are important factors for successful medication reduction.
Background:
Little is known about outcomes after stepping down asthma medications within an asthma management program.
Objective:
To determine outcomes of stepping down asthma medications in a pediatric asthma management program.
Methods:
We performed a retrospective study of 5- to 18-year-old children with asthma in an integrated primary care practice in the United States. Data were included on participants from March 1, 2009, until December 31, 2011. We first determined whether a child was eligible for step down and next recorded whether a step-down attempt was made and if the attempt was successful. In addition to descriptive statistics for the sample demographics and the outcomes of stepping down, univariate and multivariate analyses were performed to determine predictors of successful asthma medication step-down attempts.
Results:
Of the 477 children sampled for this study, 264 (55.3%) had a guideline-eligible opportunity to step down asthma medications. An attempted step down occurred in only 89 (33.7%) of children who had guideline-eligible opportunities. A total of 166 children (34.8%) attempted a step down of asthma medication at least once (including those guideline ineligible to step down). Of children with follow-up, 96 (71.6%) of step-down attempts were successful. Time of year (any season except fall) when the step down was attempted predicted successful step down in univariate and multivariate analysis (odds ratio = 3.81; 95% confidence interval, 1.23-11.85; P = .02). Being guideline eligible for step down predicted successful step down in univariate analysis only (odds ratio = 2.51; 95% confidence interval, 1.16-5.43; P = .02).
Conclusion:
Our findings from this sample of children participating in an asthma management program suggest that stepping down asthma medication based on National Asthma Education and Prevention Program 3 guidelines is frequently successful.
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