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

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.