Published Online: October 6, 2015
Trying to reduce daily asthma medicine use in patients with asthma speaks to the principle of using the least amount of medicine to control symptoms and prevent attacks. Reducing or stopping daily asthma medicines has been called “stepping down,” a description that is based on the recommended stepwise approach of adjusting asthma medicines for each patient. Deciding when to step down daily asthma medicines can be challenging, and it would be helpful for patients and their healthcare team to understand the risks involved.
In an original article recently published in The Journal of Allergy and Clinical Immunology (JACI), Rank and colleagues analyzed asthma outcomes after patients stepped down their daily asthma medicines. They used a database that included adults and children who are representative of the US population. In this database, the authors studied over 4,000 patients who were taking daily asthma medicines and focused their analysis on 2 groups: patients who had stable asthma for at least 1 year, and who stayed on their same daily asthma medicine; and patients who had stable asthma for at least 1 year who stepped down their daily asthma medicine. This study did not involve random assignment of patients to stepping down or keeping their medicines the same; therefore, to strengthen the comparison the authors controlled their analysis for many key variables that were available in the dataset.
The main findings of the study were that stepping down asthma medicines in patients who have had stable asthma for at least 1 year appears to be as safe as continuing the same level of medicines. Only 11% of patients had problems with their asthma in the 4-5 months after stepping down their asthma medicines. In addition, the study is the first to broadly consider the financial costs associated with stepping down asthma medicines. The patients who stepped down their asthma medicines saved on average $34 each month compared to those who maintained their same level of medicines. The authors did not find increased costs among those who stepped down for hospital or emergency asthma care. In addition, those who stepped down did not miss any more work or school than those who kept their medicines at the same level.
In people whose asthma has been stable for at least 1 year on daily asthma medicines, stepping down asthma medicines in this study was as safe as keeping daily medicines at the same level. This is important because many people with asthma may be able to safely reduce their asthma medicines with the appropriate guidance from their healthcare teams.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.