POEMs

One-Third of Adults with Diagnosed Asthma Can Be Weaned Off All Asthma Medications

 

Am Fam Physician. 2017 May 1;95(9):586.

Clinical Question

How many adults with physician-diagnosed asthma can safely taper off their asthma medications?

Bottom Line

This study found that current asthma was ruled out after repeated testing in one-third of adults with physician-diagnosed asthma. Patients ruled out for current asthma were less likely to be using asthma medications or daily controlling medications and less likely to have undergone testing for airflow limitation at the time of initial diagnosis. After one year of follow-up, 2.9% of the patients who tapered off their asthma medications presented with respiratory symptoms and resumed treatment. (Level of Evidence = 1b)

Synopsis

These investigators randomly dialed landline and cellular phones in Canada to identify a true cohort of adults, 18 years or older, with physician-diagnosed asthma within the previous five years. Exclusion criteria included pregnancy, smoking history greater than 10 pack-years, or the use of long-term oral steroids. Review of medical records allowed collection of data on the determination of the original diagnosis of asthma. All participants (N = 701) underwent assessment with baseline spirometry and continued symptom monitoring using standard tools, as well as serial bronchial challenge testing. Patients using daily medications and not confirmed to have asthma with baseline spirometry or serial bronchial challenge testing had their medications gradually tapered off over four study visits. Patients with continued negative test results for asthma were followed up clinically and with repeated bronchial challenges over one year. Two pulmonologists independently reviewed all medical records to determine agreement with the final diagnosis for all participants. Discrepancies were resolved by consensus agreement with a third reviewer.

A total of 613 patients (87.4%) completed the study assessment procedures. Of these, 203 (33.1%) had a diagnosis of current asthma ruled out. Patients ruled out for current asthma were less likely to be using asthma

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.

 

 

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