Assessing the Risks and Benefits of Step-Down Asthma Care: A Case-Based Approach

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• 作者：John B. Hagan (1)
  Matthew A. Rank (2)
  
  1. Division of Allergic Diseases ; Mayo Clinic ; 200 First Street S.W. ; Rochester ; MN ; 55905 ; USA
  2. Allergy ; Asthma and Clinical Immunology ; Mayo Clinic ; Scottsdale ; AZ ; USA
  
• 关键词：Asthma ; Step down ; Pharmacotherapy ; Individualized care ; Inhaled corticosteroids (ICS) ; Long ; acting beta agonist (LABA) ; Asthma guideline ; Cost of care ; Asthma monitoring ; Forced expiratory volume at 1聽s (FEV ; 1) ; Forced vital capacity (FVC) ; Bronchial hyperresponsiveness ; Methacholine challenge ; Exhaled nitric oxide ; Sputum eosinophilia ; Evidence ; based medicine ; Meta ; analysis ; Asthma control ; Adherence ; Exacerbation risk ; Medication risk ; Uncertainty
• 刊名：Current Allergy and Asthma Reports
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：15
• 期：4
• 全文大小：1,268 KB
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• 刊物主题：Allergology;
• 出版者：Springer US
• ISSN：1534-6315

文摘

Guidelines have called for pharmacologic stepped care to improve asthma treatment. Therapeutic options which have been approved provide physicians and their patients alternatives for stepping up asthma treatment to achieve control. However, few studies have been performed to identify and characterize procedures for optimal stepping-down treatment in patients with asthma. The resulting uncertainty as well as a lack of prioritization for asthma reassessment once control has been maintained has led to a lack of well-defined procedures for stepping down asthma treatment. However, recent studies provide guidance regarding the risks of stepping down asthma medications. This review uses case-based examples to demonstrate how health care providers may engage patients in discussions regarding guideline recommendations to promote individualized asthma care.