title: Assessment of biological, psychological and adherence factors in the prediction of step-down treatment for patients with well-controlled asthma.
abstract: OBJECTIVE
  Inhaled corticosteroids (ICS) and inhaled corticosteroids combined with long-acting beta2-agonist (ICS/LABA) are standard treatments for asthma. However, factors that might help reduce medication in well-controlled asthma are unknown. We classified problems of asthma patients into biological, psychological and adherence factors, and investigated factors associated with the indication and failure of a medication step-down treatment.
  
  
  METHODS
  Two hundred twenty two well-controlled asthma patients receiving ICS or ICS/LABA were assessed for physical and psychiatric problems and followed up for one year from adjustment of their treatment step. Factor B was defined as a presence of chronic upper airway complications. Factor P was defined as presence of psychiatric complications such as sleep disorder, depression, anxiety and somatoform disorders. Factor A was defined as poor adherence to ICS or ICS/LABA inhaler of 75% or less. Success in step-down treatment was defined as maintenance of well-controlled status for over one year after step-down.
  
  
  RESULTS
  Factor B was the most important single negative predictive factor for indication for step-down treatment (Odds ratio; 0.19). Factor A increased the risk of failure to maintain step-down treatment most significantly by 23-fold, and factor B increased it by 11-fold. The combination of factors B and A increased failure by 24-fold, factors P and A by 21-fold, all three factors by 36-fold. Factor P only interacted with the other factors to reduce chances of stepping down, but did not constitute a problem factor when present alone.
  
  
  CONCLUSIONS
  The evaluation of biological, psychological and adherence problems may lead to a more proactive and targeted approach to step-down treatment for patients with well-controlled asthma.
authors.affiliation: Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.|Department of Psychology, Southern Methodist University, Dallas, TX, USA.
authors.forename: N
authors.identifier: http://orcid.org/0000-0003-2239-6846
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Education Policy & Leadership, Southern Methodist University, Dallas, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kamata
authors.affiliation: Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Itoga
authors.affiliation: Department of Allergy and Respiratory Medicine, Yokote Municipal Hospital, Yokote, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tamaki
authors.affiliation: Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kayaba
authors.affiliation: Department of Psychology, Southern Methodist University, Dallas, TX, USA.
authors.forename: T
authors.initials: T
authors.lastname: Ritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D015415:Biomarkers; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D007073:Immunoglobulin E
keywords: adherence; asthma; inhaled corticosteroids; psychosocial factors; step-down treatment; upper airway comorbidity