Asthma attack risk increases after stopping low-dose corticosteroids

Patients with stable asthma who stop using low-dose inhaled corticosteroids (ICSs) are at a significantly increased risk for exacerbations over the following 6 months, show results from a systematic review and meta-analysis of published studies.

Matthew Rank (Mayo Clinic, Rochester, Minnesota, USA) and colleagues found that patients with stable asthma who discontinued low-dose ICS treatment were more than twice as likely to experience an exacerbation as those who continued taking ICSs.

Furthermore, forced expiratory volume in 1 second (FEV1), morning peak expiratory flow (PEF), and asthma symptom scores worsened after discontinuation of low-dose ICSs, "a difference that might be clinically important in some patients with asthma," say the researchers.

In total, seven randomized controlled trials (mean follow up 27 weeks), involving a total of 532 stable asthma patients who discontinued ICSs and 508 who continued ICS treatment, met the criteria for inclusion in the meta-analysis. All of the studies had an ICS run-in period of at least 4 weeks.

Examination of the pooled data revealed that patients who discontinued ICSs were 2.35 times more likely to have an exacerbation in the following 6-month period than those who continued to take ICSs.

The absolute risk difference for an asthma exacerbation was 0.23, with an event rate of 0.38 for patients who discontinued ICSs versus 0.16 for those who continued to take ICSs. The number needed to harm (for at least one exacerbation to occur) for stopping ICSs was five.

Patients who discontinued ICSs also showed a mean FEV1 decrease of 130 mL, a mean morning PEF decrease of 18 L/min, and a standardized mean increase in asthma symptoms of 0.43.

Rank et al conclude in the Journal of Allergy and Clinical Immunology: "Patients with well-controlled asthma who stop regular use of low-dose ICSs have an increased risk of an asthma exacerbation compared with those who continue ICSs."

They add: "The results of this systematic review and meta-analysis should guide discussions between patients with stable asthma and their health care providers regarding the risks and benefits of stopping low-dose ICSs."

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