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Why and how to step down chronic asthma drugs
Michael R Gionfriddo1, John B Hagan2, Matthew A Rank3
1Center for Pharmacy Innovation and Outcomes, Geisinger Health System, Forty Fort, PA, USA.
BMJ (Clinical Research Ed.)
|October 18, 2017
Summary
Asthma treatment step-down is recommended for stable patients. Safe strategies involve adjusting inhaled corticosteroids and adding other medications, avoiding complete cessation to minimize exacerbation risks.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Clinical Pharmacology
Background:
- Asthma is a prevalent chronic respiratory condition requiring ongoing management.
- Effective asthma control balances symptom relief with minimizing treatment side effects.
- Current guidelines advocate for treatment step-down in stable asthma patients.
Purpose of the Study:
- To review evidence-based strategies for stepping down asthma pharmacotherapy.
- To identify safe and effective approaches for reducing medication intensity.
- To highlight risks associated with abrupt cessation of asthma medications.
Main Methods:
- Systematic review of multiple clinical trials on asthma treatment step-down.
- Analysis of various asthma drug regimens, including inhaled corticosteroids (ICS) and long-acting bronchodilators (LABA).
- Evaluation of strategies such as dose optimization, medication addition (e.g., LTRA, allergen immunotherapy), and on-demand use.
Main Results:
- Optimizing ICS dosing during oral corticosteroid step-down is supported.
- Reducing ICS or ICS-LABA dosage, or adding LTRA or allergen immunotherapy, are viable step-down options.
- Complete cessation of ICS or LABA is associated with increased asthma exacerbation risk.
Conclusions:
- Specific step-down strategies can safely reduce asthma medication burden.
- Avoiding complete discontinuation of inhaled corticosteroids or long-acting bronchodilators is crucial.
- Implementation requires risk prediction and shared decision-making tools for effective clinician-patient communication.