Stepping down the dose of inhaled corticosteroids for adults with asthma

The Cochrane Database of Systematic Reviews has published ‘Stepping down the dose of inhaled corticosteroids for adults with asthma’.

Cochrane Library
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Asthma is a condition of the airways affecting more than 300 million adults and children worldwide. National and international guidelines recommend titrating up the dose of inhaled corticosteroids (ICS) to gain symptom control at the lowest possible dose because long-term use of higher doses of ICS carries a risk of systemic adverse events. For patients whose asthma symptoms are controlled on moderate or higher doses of ICS, it may be possible to reduce the dose of ICS without compromising symptom control.

This study aimed to evaluate the evidence for stepping down ICS treatment in adults with well-controlled asthma who are already receiving a moderate or high dose of ICS. The researchers included randomised controlled trials (RCTs) of at least 12 weeks’ duration and excluded cross-over trials, and looked for studies of adults (aged ≥ 18 years) whose asthma had been well controlled for a minimum of three months on at least a moderate dose of ICS. Studies that enrolled participants with any other respiratory comorbidity were excluded.

The authors concluded that the strength of the evidence is not sufficient to determine whether stepping down the dose of ICS is of net benefit (in terms of fewer adverse effects) or harm (in terms of reduced effectiveness of treatment) for adult patients with well-controlled asthma.

Additional well-designed RCTs of longer duration are needed to inform clinical practice regarding use of a ‘stepping down ICS’ strategy for patients with well-controlled asthma.

Read the report here


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