Update on asthma step-therapy

The 2007 NAEPP guidelines elegantly outline an evidence-based stepwise approach to evaluate, attain, and sustain asthma control. A conceptual paradigm shift in the 2007 guidelines is the focus on achievement of current asthma control to minimize future risk. Recently, the Food and Drug Administration (FDA) has revoiced concerns regarding asthma pharmacotherapy-related safety issues. In particular, they give guidance on stepping down of asthma therapy after control is achieved. Unfortunately, there are no published randomized controlled trials addressing this question, and current National Asthma Education and Prevention Program recommendations on this topic are evidence category D. This manuscript reviews some of the recent studies published since release of the Expert Panel Report 3 and FDA warnings that may add to our understanding of this issue.