Stepping Down Asthma Treatment: How and When

Details

• Alternative Title:
  Curr Opin Pulm Med
• Personal Author:
  Rogers, Linda ; Reibman, Joan
• 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 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.
  
  
• Subjects:
  Adrenal Cortex Hormones Adrenergic Beta-Agonists Anti-Asthmatic Agents Asthma Dose-Response Relationship, Drug Drug Administration Schedule Drug Therapy, Combination Humans
• Source:
  Curr Opin Pulm Med. 18(1):70-75.
• Pubmed ID:
  22081088
• Pubmed Central ID:
  PMC4083849
• Document Type:
  Journal Article
• 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
• Volume:
  18
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:721253dc0337fdcc37f421aaf1bf3025d9e97d85d23b32012b9f9e4f366ff2d8
• Download URL:
  https://stacks.cdc.gov/view/cdc/33698/cdc_33698_DS1.pdf
• File Type:
  [PDF - 44.71 KB ]