title: Outcomes of stepping down asthma medications in a guideline-based pediatric asthma management program.
abstract: BACKGROUND
  Little is known about outcomes after stepping down asthma medications within an asthma management program.
  
  
  OBJECTIVE
  To determine outcomes of stepping down asthma medications in a pediatric asthma management program.
  
  
  METHODS
  We performed a retrospective study of 5- to 18-year-old children with asthma in an integrated primary care practice in the United States. Data were included on participants from March 1, 2009, until December 31, 2011. We first determined whether a child was eligible for step down and next recorded whether a step-down attempt was made and if the attempt was successful. In addition to descriptive statistics for the sample demographics and the outcomes of stepping down, univariate and multivariate analyses were performed to determine predictors of successful asthma medication step-down attempts.
  
  
  RESULTS
  Of the 477 children sampled for this study, 264 (55.3%) had a guideline-eligible opportunity to step down asthma medications. An attempted step down occurred in only 89 (33.7%) of children who had guideline-eligible opportunities. A total of 166 children (34.8%) attempted a step down of asthma medication at least once (including those guideline ineligible to step down). Of children with follow-up, 96 (71.6%) of step-down attempts were successful. Time of year (any season except fall) when the step down was attempted predicted successful step down in univariate and multivariate analysis (odds ratio = 3.81; 95% confidence interval, 1.23-11.85; P = .02). Being guideline eligible for step down predicted successful step down in univariate analysis only (odds ratio = 2.51; 95% confidence interval, 1.16-5.43; P = .02).
  
  
  CONCLUSIONS
  Our findings from this sample of children participating in an asthma management program suggest that stepping down asthma medication based on National Asthma Education and Prevention Program 3 guidelines is frequently successful.
authors.affiliation: Division of Allergy, Asthma, and Immunology, Mayo Clinic, Scottsdale, AZ 85259, USA. rank.matthew@mayo.edu
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Rank
authors.forename: Megan E
authors.initials: ME
authors.lastname: Branda
authors.forename: Deborah B
authors.initials: DB
authors.lastname: McWilliams
authors.forename: Shirley K
authors.initials: SK
authors.lastname: Johnson
authors.forename: Shefali A
authors.initials: SA
authors.lastname: Samant
authors.forename: Jenna C
authors.initials: JC
authors.lastname: Podjasek
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Park
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Volcheck
mesh_terms: D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents