Nav: Home

Asthma Controller Step Down Yardstick -- treatment guidance for when asthma improves

January 25, 2019

ARLINGTON HEIGHTS, IL (January 25, 2019) - When asthma symptoms improve, there's reason for celebration by both allergist and patient. But once symptoms are better, how do health care practitioners go about stepping down asthma medication to make sure a patient's needs are still met? The Asthma Controller Step Down Yardstick, a new guideline from the American College of Allergy, Asthma and Immunology (ACAAI), offers an "operation manual". It helps health care professionals understand how to identify when a patient is ready to step down their treatment, and what the process might involve.

"There is a gap in information when it comes to guiding allergists and other health practitioners through the process of stepping down controller therapy," says allergist Bradley Chipps, MD, immediate ACAAI past president and lead author of the guideline. "We have yardsticks that address stepping up asthma controller medication, but this document addresses how to reverse the process for patients whose asthma has been well controlled for at least three months - or longer for the highest risk patients."

The guideline outlines both reasons for, and reasons not to consider stepping down treatment.

Consider stepping down treatment to:
  • Re-assess a current diagnosis of asthma.

  • Decrease the potential adverse effects of asthma medications.

  • Address patient and family preferences about taking medications.

  • Reduce the burden of treatment (e.g., time to take medications, remembering to take medications, having to take medications at work or school).

  • Reduce the costs of treatment.

  • Simplify therapy and enhance adherence with treatment.
Consider not stepping down treatment when:
  • Reducing asthma medication may lead to an increased risk of having an asthma exacerbation or loss of control.

  • It is unclear whether the patient is using his/her asthma medications as indicated (e.g., whether the patient has already self-reduced treatment).

  • A seasonal maintenance of therapy is needed (e.g., during the patient's allergy season or viral season).
"Stepping down controller therapy serves several purposes," says allergist Leonard Bacharier, MD, co-author of the guideline. "It identifies the minimum effective treatment that will maintain well-controlled asthma based on both impairment and risk domains. And it minimizes the risk of adverse effects from higher doses of medication(s) than may be needed to maintain control. It can also simplify the patient's treatment regimen and may enhance adherence, because reducing exposure to higher doses of medication(s) is generally consistent with patient values and preferences."

The guideline offers specific recommendations regarding appropriate medications and dosing for patients on step 2 through step 5 asthma therapy.

"Stepping down asthma therapy is an important component of managing patients with asthma, from the mildest end of the severity spectrum to the most difficult-to-treat patient," says Dr. Chipps. "Although current guidelines recommend stepping down therapy in a patient with stable asthma, the operational focus has been on how to step up treatment when asthma is inadequately controlled. This Yardstick provides recommendations for how to step-down therapy using guideline-based severity levels."
-end-
The Asthma Controller Step Down Yardstick is published online in Annals of Allergy, Asthma and Immunology, the scientific journal of ACAAI. If you are seeking additional guidance on next steps for treating your patient with asthma, check the yardstick.

About ACAAI

The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest and Twitter.

American College of Allergy, Asthma, and Immunology

Related Asthma Articles:

Physics vs. asthma
A research team from the MIPT Center for Molecular Mechanisms of Aging and Age-Related Diseases has collaborated with colleagues from the U.S., Canada, France, and Germany to determine the spatial structure of the CysLT1 receptor.
New knowledge on the development of asthma
Researchers at Karolinska Institutet in Sweden have studied which genes are expressed in overactive immune cells in mice with asthma-like inflammation of the airways.
Eating fish may help prevent asthma
A scientist from James Cook University in Australia says an innovative study has revealed new evidence that eating fish can help prevent asthma.
Academic performance of urban children with asthma worse than peers without asthma
A new study published in Annals of Allergy, Asthma and Immunology shows urban children with poorly controlled asthma, particularly those who are ethnic minorities, also suffer academically.
Asthma Controller Step Down Yardstick -- treatment guidance for when asthma improves
The focus for asthma treatment is often stepping up treatment, but clinicians need to know how to step down therapy when symptoms improve.
Asthma management tools improve asthma control and reduce hospital visits
A set of comprehensive asthma management tools helps decrease asthma-related visits to the emergency department, urgent care or hospital and improves patients' asthma control.
Asthma linked to infertility but not among women taking regular asthma preventers
Women with asthma who only use short-acting asthma relievers take longer to become pregnant than other women, according to research published in the European Respiratory Journal.
What are the best ways to diagnose and manage asthma?
A team of experts from The University of Texas Medical Branch at Galveston examined the current information available from many different sources on diagnosing and managing mild to moderate asthma in adults and summarized them.
Insomnia prevalent in patients with asthma
A team of researchers from the University of Pittsburgh has found that insomnia is highly prevalent in adults with asthma and is also associated with worse asthma control, depression and anxiety symptoms and other quality of life and health issues.
Test used to diagnose asthma may not be accurate
A new study urges caution in the use of the mannitol challenge test for asthma in non-clinical settings.
More Asthma News and Asthma Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.