Using an as-needed inhaled corticosteroids step-down strategy in stable asthma

Published online July 1, 2025

There are many strategies that can be used to step down asthma treatment in stable patients, many of whom may be clinically stable using scheduled inhaled corticosteroid (ICS).

Estrada-Medizabal and colleagues reported the results of a systematic review and meta-analysis of randomized clinical trials comparing scheduled and as-needed ICS among patients with stable asthma in The Journal of Allergy and Clinical Immunology: In Practice. 

The authors synthesized the results of seven randomized controlled trials which included 2,485 patients. The meta-analysis showed little to no difference between the scheduled and as-needed ICS groups for severe exacerbations, asthma quality of life, lung function, and severe adverse events rate. Asthma control scores favored scheduled ICS, though the effect was unlikely to be clinically important. Cumulative ICS dose was lower with as-needed ICS, a difference that could be important for potential adverse effects of ICS. The authors were moderately confident in the estimated results for each outcome. The authors concluded that patients who are stable on ICS and step down treatment to as needed  ICS are likely to have similar outcomes, and less overall medicine exposure, than patients who continue the scheduled ICS. Using ICS as-needed is a strategy for reducing asthma medicines that could be used for many people.  

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

Full Article