Abstract

Introduction 

Clinical practice guidelines recommend increasing the dose of ICS in patients not controlled with low-medium doses of ICS/LABA (step-up therapy). We analyzed the factors that determine the success of this therapeutic strategy.

Materials and Methods 

Retrospective cohort study in 1249 patients, all aged ≥18 years, with persistent asthma treated with any fixed-dose ICS/LABA combination, with increase in the ICS dose during 2016. 

Results 

The factors related to the success of the step-up were: male (p <0.001), the presence of less than two comorbidities (p <0.001), the lower level of severity and lower prior dose of ICS (p <0.001), be younger (p = 0.011), normal BMI (p = 0.007), the absence of exacerbations in the previous year (p <0.001), fewer daily symptoms, nocturnal symptoms and limitation of activities (p <0.001), higher FeNO (p <0.006), less than 3 months from clinical worsening to step-up (p <0.039), and the type of ICS/LABA fixed-dose combination (p <0.001). Eosinophilia, bronchodilator test, FEV1, atopy or smoking were not related to success.

Conclusions 

The previous severity, co-morbidities, gender, baseline ICS dose, FeNO, presence of previous exacerbations and symptoms intensity influence whether patients achieve asthma control with step-up strategy. It is probable that the type of ICS/LABA combination also plays a role.

Sponsor: Mundipharma Pharmaceuticals SL (Step Study)