When your asthma is stable, you may want to stop using your low-dose inhaled corticosteroids (ICSs), as you believe your wellbeing is now under control. However, if you do so, your wellness will be at a significantly increased risk for exacerbations over the following 6 months. This is according to a systematic review and meta-analysis of published studies, published in the Journal of Allergy and Clinical Immunology, which found that patients with stable asthma who discontinued low-dose ICS treatment were more than twice as likely to experience an exacerbation as those who continued taking ICSs.
Led by Matthew Rank of the Mayo Clinic in Rochester, Minnesota, USA, the team of researchers also found that patients’ scores of forced expiratory volume in one second (FEV1), morning peak expiratory flow (PEF), and asthma symptoms worsened after discontinuation of low-dose ICSs. The researchers explained that this is ‘a difference that might be clinically important in some patients with asthma.’ For the research, the investigators looked at seven randomized controlled trials with an average follow up 27 weeks. This involved a total of 532 stable asthma patients who discontinued ICSs and 508 who continued ICS treatment, and each study had an ICS run-in period of a minimum of four weeks.
When the researchers examined the pool of data, they discovered that those who discontinued ICSs were 2.35 times more likely to have an exacerbation in the following 6-month period than those who continued to take ICSs. On average, patients who discontinued ICSs also showed a FEV1 decrease of 130 mL, a morning PEF decrease of 18 L/min, and a standardized mean increase in asthma symptoms of 0.43. The absolute risk difference for an asthma exacerbation was 0.23, with an event rate of 0.38 for patients who discontinued ICSs versus 0.16 for those who continued to take ICSs.
‘Patients with well-controlled asthma who stop regular use of low-dose ICSs have an increased risk of an asthma exacerbation compared with those who continue ICSs,’ The research team concluded in their report. ‘The results of this systematic review and meta-analysis should guide discussions between patients with stable asthma and their health care providers regarding the risks and benefits of stopping low-dose ICSs.’
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