Asthma Worsens When Inhaled Corticosteroids Are Stopped?

ANAHEIM, California — People whose asthma is stable and who decide as a result to stop taking their controller inhaled corticosteroid are putting themselves at increased risk for an exacerbation of their disease, researchers said here at the American College of Allergy, Asthma & Immunology (ACAAI) 2012 Annual Scientific Meeting.

Current asthma guidelines suggest that patients and their healthcare providers think about decreasing or stopping regular use of controller medications when the asthma is stable, said Matthew A. Rank, MD, from Mayo Clinic, Scottsdale, Arizona.

But according to his research, this may not be such a good idea in some patients.

"We found an increased risk for asthma attacks in patients who stop their chronic asthma medicines, but also found a large population of people with asthma who do very well after stopping their chronic asthma medicine," Dr. Rank told Medscape Medical News.

"We believe that treating patients with the least amount of medicines that controls their symptoms and reduces asthma attacks to an acceptable level is the best way to manage asthma over the long term," he said.

Such a treatment plan often involves decreasing or even stopping the long-term use of asthma medicines.

Making an Informed Decision

"We wanted data to help patients and their providers make informed decisions about the risks involved in stopping chronic asthma medications," Dr. Rank said.

He and his team identified studies that randomly assigned people either to continue or to stop their low-dose inhaled corticosteroids. They then pooled the data to form estimates of risk. The 7 trials in the meta-analysis all had a stable asthma run-in period of 4 weeks or longer and a follow-up period of at least 3 months.

According to data pooled from the trials, with a mean follow-up of 27 weeks, individuals who stopped taking their medication after being stable for at least 4 weeks were more than twice as likely to have an asthma exacerbation compared with those who continued to take their medication (relative risk, 2.35; 95% confidence interval [CI], 1.88 - 2.92; P < .001).

The pooled absolute risk showed that 16% of patients who continued their medication had an asthma attack in the next 6 months compared with 38% of patients who stopped their medication (P < .001).

Additionally, patients who discontinued their medication had a mean decrease in forced expiratory volume in 1 second (FEV₁) of 130 ml (range, 40 - 210 ml; P =.003), a decreased mean morning peak expiratory flow (PEF) of 18 L/min (range, 6 - 29 L/min; P = .004), and an increase in asthma symptoms (P < .001) compared with those who continued.

"Doctors can tell their patients who are controlled on low doses of inhaled steroids that their chances of having an asthma attack in the 6 months after stopping are about 1 in 3, while their chances if they continue are about 1 in 6," Dr. Rank said.

"We would like our data to inform discussions that patients and their providers have about stopping their chronic asthma medicines," he added.

Study Emphasizes Chronic Nature of Asthma

"This is an interesting article that reinforces the chronic inflammatory nature of asthma and highlights the need for further research in the field of inflammometry," commented John Oppenheimer, MD, clinical professor of medicine at New Jersey Medical School, in Newark.

"If we could develop better measures to assess potential ongoing inflammation despite symptom control, it is hoped that we can better determine who will maintain good vs loose control with the tapering or discontinuation of controller therapy," Dr. Oppenheimer, who was not part of the study, said.

Dr. Rank has disclosed no relevant financial relationships. Dr. Oppenheimer reports financial relationships with GlaxoSmithKline, Merck, AstraZeneca, Boehringer Ingelheim, MedImmune, and Novartis.

American College of Allergy, Asthma & Immunology (ACAAI) 2012 Annual Scientific Meeting: Abstract 40. Presented November 11, 2012.