Physicians' attitudes towards step-down asthma treatment in Turkey: a nationwide perspective

The cornerstone of asthma management is the stepwise approach recommended by both national and international guidelines. In this study, we aim to investigate physicians' attitudes and approaches towards step-down treatment in asthma management in Turkey. In this cross-sectional study, questionnaire-based data were gathered from pulmonologists, immunology and allergy specialists and immunology and allergy fellows in November-December 2024. Of the 225 physicians, the median years of service in their speciality was 5 (min1-max51) years. Nearly 35% of survey participants rarely step down asthma medication (12.9% and 52.4% of participants always and frequently, respectively). The two most selected barriers were 'I am afraid the patient will get worse' (50.9%) and 'patients don't want to' (29.9%). Participants whose primary concern regarding step-down asthma treatment was fear of patient deterioration were found to use step-down approaches less frequently (66.7%, p < 0.001). Working in educational and research hospitals, the fear that the patient may worsen, and infrequent adherence to guideline updates were significantly associated with the rare implementation of step-down treatment in asthma management. Our study identified that the fear of potential disease worsening and infrequent adherence to updated guidelines were significantly associated with the limited implementation of step-down treatment in asthma management.