A Simple Score for Future Risk Prediction in Patients with Controlled Asthma Who Undergo a Guidelines-Based Step-Down Strategy

Background The minimum controlling dose of treatment must be established in patients with asthma, but the outcome of step-down is unpredictable. Objective To identify factors associated with risk of control loss when stepping down asthma treatment and to develop a score to predict this risk. Methods A prospective, multicenter study including adults with well-controlled asthma was performed. Treatment was stepped up or stepped down over a 12-month period to maintain asthma control. We determined associations between clinical and functional variables and step-down failure. Finally, we derived a score to predict loss of control in 1 cohort and validated it in an independent cohort. Results The derivation cohort consisted of 228 patients; 218 completed at least 1 step-down episode and a total of 495 step-down episodes were evaluated. A medical-record documented postbronchodilator spirometry result of 1 )/forced vital capacity (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.26-3.43), current FEV 1 P P 8 implies a high risk (>40%). Conclusion This score can facilitate the prediction of step-down failure before medication taper in patients with well-controlled asthma.