Is it Safe to Step Down Medication in Patients with Controlled Asthma?

Stepping down medications in patients with controlled asthma yielded similar outcomes and lower costs compared to those who maintained treatment levels, according to a recent study.

For their study, researchers evaluated patients with persistent asthma from the US Medical Expenditure Panel Survey between the years of 2000 to 2010 to compare the safety and costs of lowering asthma controller medications to maintaining current treatment levels.

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“Eligibility for stepping down asthma controller medications included no hospitalizations or emergency department visits for asthma in periods 1 to 3 and no systemic corticosteroid and 3 or less rescue inhalers dispensed in periods 2 and 3,” explained the authors of the study.

“Steps were defined by type and dose of chronic asthma medication based on current guidelines when comparing period 4 with period 3,” they said.

Researchers defined period 5 primary outcome of complete asthma control as no asthma-related emergency department visits and hospitalizations, and 2 or less dispensed rescue inhalers.

After using multivariable analyses, researchers found that 4235 of patients (29.9%) met the criteria and eligibility to step down medication.

Of those who stepped down, 89.4% showed preserved asthma control compared to 83.5% of patients who maintained their treatment level despite being eligible to step down.

The investigators noted that $34,02 was the mean monthly asthma-related cost savings for those who stepped down compared to patience maintaining their treatment level.

“Stepping down asthma medications in those whose symptoms were controlled led to similar clinical outcomes at reduced cost compared with those who maintained their current treatment level,” they concluded.

-Michelle Canales Butcher

Rank MA, Liesinger JT, Branda ME, et al. Comparative safety and costs of stepping down asthma medications in patients with controlled asthma. J Allergy Clin Immunol. 2015 November [epub ahead of print] doi: