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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Stepping down asthma treatment: how and when.

Linda Rogers1, Joan Reibman

  • 1New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA. linda.rogers@nyumc.org

Current Opinion in Pulmonary Medicine
|November 15, 2011
PubMed
Summary
This summary is machine-generated.

Asthma medication reduction is possible with non-inhaled corticosteroid (ICS) controllers. For ICS/long-acting beta agonist (LABA) therapy, tapering ICS before LABA discontinuation may be best, but more data is needed.

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Area of Science:

  • Pulmonology
  • Allergology
  • Pharmacology

Background:

  • Asthma management guidelines recommend reducing medication once control is achieved.
  • Optimal inhaled corticosteroid (ICS) dosing and the role of non-ICS controllers in treatment reduction require clarification.
  • Long-acting beta agonist (LABA) safety concerns complicate ICS/LABA therapy step-down strategies.

Purpose of the Study:

  • To review the current strategies and evidence regarding asthma medication reduction.
  • To explore the role of non-ICS controllers in reducing inhaled corticosteroid (ICS) doses.
  • To address the complexities of stepping down ICS/long-acting beta agonist (LABA) therapy.

Main Methods:

  • Literature review focusing on current evidence for asthma medication reduction.
  • Analysis of studies investigating non-ICS controllers in asthma management.
  • Examination of strategies for stepping down ICS/LABA combination therapy.

Main Results:

  • Intermittent ICS treatment is a viable strategy for mild asthma control.
  • Non-ICS controllers (leukotriene modifiers, LABAs, omalizumab) facilitate ICS dose reduction.
  • ICS doses adequate for symptom control may not prevent exacerbations; reducing ICS before LABA discontinuation may be more effective.

Conclusions:

  • Non-ICS controllers enable ICS dose reduction with improved outcomes.
  • Tapering ICS before LABA discontinuation is a potential strategy for ICS/LABA therapy, pending further long-term safety data.
  • The lowest effective ICS dose for controlling both asthma impairment and exacerbation risk requires further determination.