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Stepping Down Asthma Treatment: How and When
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  • 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.


    Use of non-ICS controllers allow 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.

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  • Funding:
    1E11OH009630/OH/NIOSH CDC HHS/United States
    5R01 ES10187-10/ES/NIEHS NIH HHS/United States
    5T32ES07267-20/ES/NIEHS NIH HHS/United States
    T32 ES007267/ES/NIEHS NIH HHS/United States
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