Is Your Asthma Under Control?

Maybe it’s time to consider a management ‘step down’

Inhaler in foreground on doctor's desk

Your asthma treatment plan isn’t static. (And that’s a good thing!) It’s initially based on an assessment of your asthma severity, but it’s important to know it is re-evaluated each time you see your asthma care provider. This helps determine whether your asthma is well-controlled.

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If your asthma isn’t well-controlled, your asthma care provider will assess several factors that may account for your asthma not being optimally controlled. These include:

Your provider may also recommend a ‘step up’ in management. This could include an increased dose of the medication you’re already taking, or adding additional medications.

But if your asthma has been well-controlled for several months, asthma experts now suggest you consider a ‘step down.’ This could include decreasing the amount (or number) of medications you take.

“The goal is to find the minimum amount of medication required to maintain well-controlled asthma,” says David Lang, MD, Chairman of the Department of Allergy and Clinical Immunology.

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Why step down?

There are several good reasons to consider backing off your medications. They include:

  • Minimizing the risk of adverse effects from asthma medications.
  • Simplifying your treatment plan, which increases the likelihood you’ll take your meds as prescribed.
  • Potentially reducing your healthcare costs.

Don’t attempt it alone

Stepping down asthma controller therapy should only be done under a physician’s guidance. There are guidelines that give doctors specific instruction on how the process should safely be done.

And be reassured: The idea of reducing your meds shouldn’t frighten you.

If your asthma control lapses with a ‘step down’ in management, you should once again begin taking your previous level of medicine that well-controlled your asthma.

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Is stepping down right for you?

Only patients at low risk for exacerbations (that’s an increase in severity of symptoms) should consider tapering their treatment. In general, it’s reserved for patients who have been well-controlled for three to six months.

Whether or not you’d like to proceed with a ‘step down’ in asthma management is an individual decision.

“When given the option, some patients prioritize maintaining asthma control ― avoiding the risk that their asthma may flare,” Dr. Lang says. “Others prioritize the opportunity to reduce their need to rely on medication, with the understanding that their asthma control may lapse. There’s no right or wrong decision: It depends what the individual values and prefers.”

If your asthma is well-controlled and you’re interested in exploring the possibility of a step down, discuss this with your asthma care provider. “It’s an opportunity for shared decision-making,” he says.

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