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

Sunny Jabbal, Arvind Manoharan, William Anderson, Brian Lipworth

Research output: Contribution to journalMeeting abstract

Abstract

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.
Original languageEnglish
JournalEuropean Respiratory Journal
Volume48
Issue numberSuppl60
DOIs
Publication statusPublished - 8 Nov 2016

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Asthma
Oscillometry
Lung
Airway Resistance
Albuterol
Spirometry
Primary Health Care
Patient Care
Prospective Studies
Guidelines
Therapeutics

Keywords

  • asthma management
  • Breath Test
  • Tranplantation

Cite this

@article{b546a3aa12a04704b8d0faf842d234a3,
title = "LATE-BREAKING ABSTRACT: Real life impact of long acting beta-2-agonist withdrawal in controlled step 3 asthma patients",
abstract = "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.",
keywords = "asthma management, Breath Test, Tranplantation",
author = "Sunny Jabbal and Arvind Manoharan and William Anderson and Brian Lipworth",
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volume = "48",
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LATE-BREAKING ABSTRACT: Real life impact of long acting beta-2-agonist withdrawal in controlled step 3 asthma patients. / Jabbal, Sunny; Manoharan, Arvind; Anderson, William; Lipworth, Brian.

In: European Respiratory Journal, Vol. 48, No. Suppl60, 08.11.2016.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - LATE-BREAKING ABSTRACT: Real life impact of long acting beta-2-agonist withdrawal in controlled step 3 asthma patients

AU - Jabbal, Sunny

AU - Manoharan, Arvind

AU - Anderson, William

AU - Lipworth, Brian

N1 - no funding information

PY - 2016/11/8

Y1 - 2016/11/8

N2 - 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.

AB - 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.

KW - asthma management

KW - Breath Test

KW - Tranplantation

U2 - 10.1183/13993003.congress-2016.OA4829

DO - 10.1183/13993003.congress-2016.OA4829

M3 - Meeting abstract

VL - 48

JO - European Respiratory Journal

JF - European Respiratory Journal

SN - 0903-1936

IS - Suppl60

ER -