What happens when inhaled steroids are stopped?

Published Online: Janaury 14, 2013

Asthma is a common and burdensome problem, with symptoms that may change over time. Taking regular asthma medications, such as inhaled corticosteroids, can reduce symptoms and decrease the risk of asthma attacks. When asthma is stable, providers may discuss stepping down or discontinuing asthma medicines with their patients. Current guidelines suggest that providers consider stopping (or decreasing) asthma medicines after a period of stable asthma (3-12 months), but the evidence to support these recommendations is limited.

In an article recently published in The Journal of Allergy and Clinical Immunology (JACI), Rank et al. identified clinical trials that involved patients who were stable on a low dose of inhaled corticosteroid and were randomized to either continue or stop the inhaled corticosteroid. The authors performed a systematic search to identify potential articles to include for the study and used established research methods to analyze the data. The data from the resulting clinical trials were pooled together to calculate an estimated risk for having an asthma attack after stopping low-dose inhaled corticosteroids.

The authors identified 1,798 articles using a search strategy that was developed with the aid of with an experienced medical librarian. From these, 172 articles were reviewed in more detail and 7 were ultimately found to meet the pre-specified inclusion criteria. The authors found that those who stopped low-dose inhaled corticosteroids had two times higher risk of having an asthma attack in the next six months than those who continued the inhaled corticosteroid. This difference in risk meant that approximately one in six patients with asthma had an attack in the next six months if they continued their treatment with a low-dose inhaled corticosteroid, and one in three patients had an attack if they stopped the low-dose inhaled corticosteroid.

The authors report on the first attempt to pool information from clinical trials about the risks for asthma attacks after stopping low-dose inhaled corticosteroids. While the authors found an increased risk with stopping asthma medicines, they also noted that many people (two out of three) did very well even after stopping their asthma medicines. The findings from this study can serve as a discussion point for patients with stable asthma and their providers as they decide whether to continue or stop their current asthma medicines.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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