Stepping down asthma treatment: how and when

Details

• Personal Author:
  Reibman J ; Rogers L
• Description:
  PURPOSE OF REVIEW: Guidelines suggest that asthma medication should be reduced once asthma control is sustained. Moderate-dose inhaled corticosteroids (ICS) can typically be reduced, but questions remain about the lowest effective ICS dose and the role of non-ICS controllers in treatment reduction. Long-acting beta agonist (LABA) safety concerns have created controversy about how to step down patients on ICS/LABA therapy. This review will focus on the current status of these issues. RECENT FINDINGS: Intermittent ICS treatment, often in fixed combination with short-acting beta agonist, is an emerging strategy for control of mild asthma. Addition of leukotriene modifiers, LABAs, and omalizumab to ICS can allow for reduced ICS dosing. Doses of ICS that control symptoms may be inadequate to control exacerbations. Reducing ICS dose before discontinuing LABAs may be the more effective approach for patients on combination therapy. SUMMARY: Use of non-ICS controllers allows for ICS dose reduction with superior outcomes. Tapering of ICS prior to LABA discontinuation may be the favored approach for patients on ICS/LABA therapy, but an understanding of long-term outcomes and further safety data are required. The lowest ICS dose that adequately controls both asthma impairment and risk remains to be determined. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Biopharmaceutics Drug Therapy Occupational Health Respiratory Tract Diseases Safety
• Keywords:
  Author Keywords: Asthma Biological-effects Bronchial-asthma Control-methods Corticosteroids Dose-response Drug-therapy Drugs Inhaled Corticosteroids Long-acting Beta Agonists Medical-treatment Medicinal-chemicals Pharmaceuticals Respiratory-system-disorders Step-down

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• ISSN:
  1070-5287
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  70-75
• Volume:
  18
• Issue:
  1
• NIOSHTIC Number:
  nn:20040312
• Citation:
  Curr Opin Pulm Med 2012 Jan; 18(1):70-75
• Contact Point Address:
  Linda Rogers, MD, FCCP, New York University School of Medicine, 550 First Avenue, New Bellevue 7N24, New York, NY 1006, USA
• Email:
  linda.rogers@nyumc.org
• Federal Fiscal Year:
  2012
• Performing Organization:
  New York City Health and Hospitals Corporation
• Peer Reviewed:
  True
• Start Date:
  20080929
• Source Full Name:
  Current Opinion in Pulmonary Medicine
• End Date:
  20110928
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:301eb3714b8d2e7d95b3b508677409fd95ff4b0dcfada9e5625ed08a6e08a577923dae94035bb72d51b450b0d75eb0fdcc4e7d2a4b38b3926f22fd09079e3602
• Download URL:
  https://stacks.cdc.gov/view/cdc/193239/cdc_193239_DS1.pdf
• File Type:
  [PDF - 239.35 KB ]