Adjusting treatment in patients with asthma. The GEMA-Forum task force

Background: Asthma can be controlled through dose adjustment. Yet, there is not enough evidence available about the adjustment of asthma controllers in order for guidelines to strongly suggest stepping up or stepping for optimum control. Objectives: Gathering opinions from a large number of Spanish experts in asthma management in order to put together a series of practical recommendations about treatment adjustment. Method: After going over scientific evidence and assembling eleven groups, which would carry out simultaneous discussions aimed at topics previously agreed upon during start-up meetings, a modified Delphi survey was conducted in order to gather the opinion of seventy five healthcare experts on treatment adjustment in asthma. Results: After two discussion rounds, consensus was reached about 88.3% of the items previously selected for discussion. Such consensus included the following notions: Step-up therapy should be considered in severe asthma after 6-12 months, and in non-severe asthma after 3-6 months. Step-down therapy should be considered in controlled patients without exacerbations. Maintenance is important during pregnancy. Dose adjustment should be necessary in the treatment of seasonal allergy. Patients receiving immunotherapy or biologics may require treatment adjustment. Conclusions: Every asthma patient requires a personalized approach, depending on such factors as previous control of asthma, severity of exacerbations, lung function, seasonal allergy, pregnancy and concomitant treatments.