{"title":"Factors Associated with Failure of Stepping-Down Treatment in Pediatric Asthma","authors":"W. Krobtrakulchai","doi":"10.1055/s-0043-1768243","DOIUrl":null,"url":null,"abstract":"Abstract Background The international and Thai asthma guidelines recommend stepping-down controller treatment in patients whose asthma symptoms have been controlled and maintained for 3 months or longer. After stepping-down treatment, some patients experienced exacerbations and required emergency care. There is limited understanding of stepping-down treatment for asthmatic children. The goal of this study was to determine the failure rate and associated factors after stepping-down treatment in pediatric asthma. Methods A retrospective study of electronic medical records of asthmatic patients aged between 3 and 15 years with controlled symptoms and indications for stepping-down treatment was conducted at Maharat Nakhon Ratchasima Hospital, a tertiary care center in Northeast Thailand, between January 2015 and December 2019. Results Of the 110 asthmatic patients with well-controlled asthma who received stepping-down treatment, 90 patients were followed over 12 months. Failure of treatment within 12 months of follow-up was 37.8% (34 of 90). Patients who failed to stepping-down treatment had asthma onset at a younger age ( p = 0.026) and less than 9 months duration of asthma stability before stepping-down ( p = 0.049). In multivariate analysis, the factor associated with failed stepping-down treatment was the length of asthma stability of fewer than 9 months with an odds ratio of 4.8 (95% confidence interval: 1.02–22.47). Conclusion Stepping-down treatment in well-controlled pediatric asthma resulted in a high failure rate. The author suggests initiating stepping-down treatment in patients whose duration of asthma stability is greater than 9 months may improve the rate of success.","PeriodicalId":41283,"journal":{"name":"Journal of Child Science","volume":"13 1","pages":"e35 - e39"},"PeriodicalIF":0.3000,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Child Science","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0043-1768243","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Abstract Background The international and Thai asthma guidelines recommend stepping-down controller treatment in patients whose asthma symptoms have been controlled and maintained for 3 months or longer. After stepping-down treatment, some patients experienced exacerbations and required emergency care. There is limited understanding of stepping-down treatment for asthmatic children. The goal of this study was to determine the failure rate and associated factors after stepping-down treatment in pediatric asthma. Methods A retrospective study of electronic medical records of asthmatic patients aged between 3 and 15 years with controlled symptoms and indications for stepping-down treatment was conducted at Maharat Nakhon Ratchasima Hospital, a tertiary care center in Northeast Thailand, between January 2015 and December 2019. Results Of the 110 asthmatic patients with well-controlled asthma who received stepping-down treatment, 90 patients were followed over 12 months. Failure of treatment within 12 months of follow-up was 37.8% (34 of 90). Patients who failed to stepping-down treatment had asthma onset at a younger age ( p = 0.026) and less than 9 months duration of asthma stability before stepping-down ( p = 0.049). In multivariate analysis, the factor associated with failed stepping-down treatment was the length of asthma stability of fewer than 9 months with an odds ratio of 4.8 (95% confidence interval: 1.02–22.47). Conclusion Stepping-down treatment in well-controlled pediatric asthma resulted in a high failure rate. The author suggests initiating stepping-down treatment in patients whose duration of asthma stability is greater than 9 months may improve the rate of success.