DEPRESCRIBING LONG ACTING BETA2 AGONISTS IN CHILDREN AND ADOLESCENTS WITH STABLE ASTHMA: A SYSTEMATIC REVIEW

IntroductionCurrent guidelines recommend step-down of asthma drugs once stable asthma has been achieved but there is no guidance regarding deprescribing long acting beta2 agonists (LABAs) in the paediatric population.AimTo systematically review evidence regarding deprescribing methods of LABAs in the paediatric population.MethodsSearches were undertaken in the following databases: EMBASE, Medline, PubMed and CINAHL regarding reports of deprescription or discontinuation of LABAs in children and adolescents with persistent asthma.ResultsThe search returned 168 papers following deduplication. 4 papers met the eligibility criteria including 3 randomised control trials and 1 retrospective study. Overall, LABA step down was attempted in 365 children and young people (5–18 years old). The studies had variable follow up durations once deprescribing was undertaken, from 2 to 12 weeks. Effects of withdrawal were measured using parameters such as airway hyperresponsiveness tests (3 studies), asthma control test scores (3 studies), use of rescue medication (3 studies) and lung function tests (FeNO, FEV1, FEF25–75%, peak expiratory flow rate (PEFR),% forced expiratory flow at 50% of vital capacity (%V50)) (all studies). Airway responsiveness was unchanged 2 weeks following LABA withdrawal, however decreases in%PEFR and%V50, FEV1 and asthma control test scores were observed. 2 studies assessed changes in LABA related adverse effects after deprescribing.ConclusionThere is limited and short-term evidence regarding stepping down LABAs in paediatrics. To fully implement national and international guidelines, prospective studies in this area are required.