Maintenance of inhaled corticosteroids (ICS) is recommended in adult asthmatics. However, adherence rates in patients with mild asthma and side effects of long-term ICS use can lead to withdrawal.
We analyzed the real-world outcomes of ICS withdrawal by analyzing data from the Korean National Health Insurance (NHI) database.
Based on claims data from the NHI of Korea between 2011 and 2014, we identified patients diagnosed with asthma without chronic obstructive pulmonary disorder (COPD) or long-term systemic steroid use who had an ICS medication possession rate of > 50% in a year. We compared patients who received ICS consistently (maintenance group) with patients who had no ICS prescription for more than 6 months (withdrawal group). We evaluated exacerbation leading to prescription of systemic steroid and emergency department (ED) visit or hospitalization.
Excluding COPD patients and long-term systemic steroid users, we identified 145,511 patients for the asthma cohort (Mean age 60.0, ever smoker 63.5%): 132,175 maintained ICS and 13,336 withdrew ICS for more than 6 months. Only 71 patients (0.5%) experienced exacerbation leading to an ED visit or hospitalization in the withdrawal group. ICS was restarted within one year for 33.6% of the withdrawal group, and 90% of those patients restarted ICS within 158 days.
This nationwide study of asthmatics, characterized by a high proportion of elderly and smokers, showed that ICS withdrawal in about 10% of patients appeared to confer relatively minimal harm and exacerbation leading to hospitalization was not common. Further prospective studies are warranted to carefully explore the safety of ICS withdrawal in younger, non-smoking and well controlled asthmatic patients.

Copyright © 2020. Published by Elsevier Inc.