LATE-BREAKING ABSTRACT: Real life impact of long acting beta-2-agonist withdrawal in controlled step 3 asthma patients

Background: GINA guidelines state asthma patients should be on the lowest treatment step to achieve control. In clinical practice more often patients are stepped up to ICS/LABA than stepped down. We hypothesise that LABA withdrawal may be safely done in controlled patients.
Methods: We evaluated 58 stable, step 3 asthma patients from primary care. Spirometry, Impulse oscillometry and FeNO were performed at baseline. After this LABA was stopped and ICS dose was reduced. Patients attended 3 weeks afterwards for repeat tests.
Results: None of the patients were current smokers, and all were receiving ICS/LABA:, mean FEV1 88% predicted, peak flow 101% predicted, and were well controlled having had no exacerbations in the last 3 months prior to screening. Our results showed no significant change in symptom score, salbutamol use, or pulmonary function at 3 weeks after stopping LABA. Mean values pre & post were: R5 (total airway resistance) 0.48 versus 0.47 kPa/L.s; FEV1 2.89 versus 2.88 L; PEF 462 versus 462 L/min; FeNO 38 versus 36 ppb. The absence of change occurred despite a concomitant mean 20 % reduction in ICS dose (664 to 530 µg, P<0.0005).
Conclusion: In real life well controlled patients on ICS/LABA may safely undergo LABA withdrawal without loss of control or decline in pulmonary function, at least in the medium term. This in turn perhaps suggests that ICS/LABA treatment may be overprescribed. Large scale prospective studies are required to analyse how this may impact on long term outcomes such as exacerbations.