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Stepping down of controller treatment in moderate asthma

Published online: October 1, 2021

Current asthma guidelines recommend the stepping down of controller treatment when the condition is well-controlled for a certain length of time. However, an optimal stepping-down strategy for patients receiving a low-dose inhaled corticosteroid (ICS) with a long-acting β2 agonist (LABA) remains unclear.

In a randomized, open-label, pragmatic trial in The Journal of Allergy and Clinical Immunology: In Practice, Kim et al. compared two kinds of step-down approaches (discontinuing LABA and reducing ICS/LABA to once daily) to maintaining treatment (maintaining low-dose ICS/LABA).

The results showed that the two guideline-recommended stepping-down strategies (discontinuing LABA and reducing ICS/LABA to once daily) were not non-inferior to maintaining treatment in patients well-controlled with low dose ICS/LABA. Although over 90% of patients maintained control, higher rates of loss of control were identified following 6 months after step-down. In conclusion, step down can be attempted when patients are stable, but appropriate monitoring and supervision are necessary with precautions for loss of control.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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