How to step down asthma preventer treatment in patients with well-controlled asthma - more is not always better

How to step down asthma preventer treatment in patients with well-controlled asthma -more is not always better SUMMARY Most of the benefit of asthma preventer inhalers is seen with low doses.However, many Australian patients are prescribed doses of inhaled corticosteroids that are higher than necessary to control their asthma.Prescribing unnecessarily high preventer doses increases the patient's risk of adverse effects.They may also increase the patient's out-of-pocket costs.Asthma guidelines recommend considering a step-down in preventer treatment after asthma has been well controlled for two to three months in adults and for six months in children.The stepdown process should be individualised for each patient.Preventive therapy should not be stopped completely.LABA. 4 There are several possible explanations for this deviation from the recommendations.Some patients with frequent symptoms at diagnosis may have been prescribed a high-dose preventer, without the dose being reviewed after the symptoms improved.Many patients have their preventer dose increased during a flare-up, but few return for review after they have recovered, so they remain indefinitely on unnecessarily high doses.5 In some cases, clinicians, given the substantial pressures on their time, feel that switching asthma treatment may not be a worthwhile use of their time, especially if there is a risk that asthma control will be worse after the switch.6 Why consider stepping down asthma treatment?Most of the benefits of ICSs are achieved with low doses which are associated with very little risk of adverse effects.Long-term treatment with high doses is associated with a small increase in the background risk of conditions such as cataract and osteoporosis.7 Some patients are concerned about any type of corticosteroid treatment, 8 with some concerns mistakenly driven by information about anabolic steroids.Patients may not be aware that the risks described in Consumer Medicines Information are seen only with high ICS doses taken for a long period of time, or with oral corticosteroids.When starting treatment, prescribers should emphasise to the patient that one of the goals of asthma management is to first achieve good control and then find the lowest dose for them that will keep the asthma well controlled.