May 6, 2019/Lung

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.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

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.


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.

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.

Learn more about our editorial process.

Related Articles

Person holding cup of hot tea, with honey jar floating in background
February 23, 2024/Ear, Nose & Throat
Why Your Throat Tickles — And How To Stop It

Often, a throat tickle is due to a cold, allergies or GERD — but see a doctor if it won’t go away

male sitting on couch using inhaler and holding chest
January 9, 2024/Lung
Understanding the Difference Between Asthma and COPD

Both conditions have similar symptoms, but different causes and treatments

male doing yoga breathing exercises seated on a bed
December 17, 2023/Lung
Should You Try an Alternative Asthma Treatment?

The effectiveness and safety of many of these options are unknown, so it’s best to stick to traditional care

asthma triggers floating around a set of lungs and a person
December 10, 2023/Lung
How To Stop an Asthma Cough

Avoid triggers like dust, smoke and cold air to lessen your chances of coughing

woman in her forties, using an inhaler
November 27, 2023/Lung
Why Sex Hormones Can Help (or Hurt) Your Asthma

Developmental changes like puberty and menopause can impact symptom severity

A child and a man both using an inhaler
August 17, 2023/Lung
Can You Outgrow Asthma?

Symptoms may lessen over time, but the condition never truly goes away

person using an inhaler
May 14, 2023/Infectious Disease
What Are the Long-Term Effects of RSV?

People with certain pre-existing medical conditions have increased risk factors

Thick smog in heavy traffic.
February 28, 2023/Lung
How Pollution Impacts Your Health

The type, quantity and duration of your exposure determines your risk of injury or illness

Trending Topics

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

woman snacking on raisins and nuts
52 Foods High In Iron

Pump up your iron intake with foods like tuna, tofu and turkey