Factors Associated with Failure of Stepping-Down Treatment in Pediatric Asthma

IF 0.3 Q4 PEDIATRICS
W. Krobtrakulchai
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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.
儿童哮喘降压治疗失败的相关因素
摘要背景 国际和泰国哮喘指南建议,哮喘症状已得到控制并维持3个月或更长时间的患者停止控制治疗。在停止治疗后,一些患者病情恶化,需要紧急护理。对哮喘儿童的降压治疗了解有限。本研究的目的是确定儿童哮喘停止治疗后的失败率和相关因素。方法 2015年1月至2019年12月,在泰国东北部的三级护理中心Maharat Nakhon Ratchasima医院对年龄在3至15岁之间、症状和停止治疗指征得到控制的哮喘患者的电子病历进行了回顾性研究。后果 在接受降压治疗的110名哮喘控制良好的哮喘患者中,90名患者接受了12个月的随访。随访12个月内治疗失败率为37.8%(34/90)。未能停止治疗的患者哮喘发病年龄较小(p = 0.026)和降压前哮喘稳定期小于9个月(p = 0.049)。在多变量分析中,与降压治疗失败相关的因素是哮喘稳定期小于9个月,比值比为4.8(95%置信区间:1.02–22.47)。结论 在控制良好的儿童哮喘中,逐步减少治疗会导致高失败率。作者建议,对哮喘稳定期超过9个月的患者开始降压治疗可以提高成功率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
0.50
自引率
0.00%
发文量
19
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