title: Step-down therapy in asthma: a focus on treatment options for patients receiving inhaled corticosteroids and long-acting beta-agonist combination therapy.
abstract: The management of asthma requires continual reassessment of disease activity and modification of treatment approaches based on the level of asthma control. Among patients receiving combination therapy with inhaled corticosteroids and long-acting beta-agonists (LABAs), asthma guidelines  and guidance from the Food and Drug Administration recommend consideration of step-down therapy when asthma control has been achieved. This report reviews the evidence base surrounding medical decision making for patients receiving combination therapy. Several studies have examined the effects  of step-down therapy in patients receiving combination therapy. Interpretation of these studies is complicated by lack of confirmation of necessity of combination therapy, varying definitions of asthma control before step-down along with variable durations of asthma control before step-down  therapy. Overall, most studies indicate that the discontinuation of LABA after a brief period of asthma control is generally followed by loss of asthma control. The consideration of step-down in asthma medications is an essential component of asthma care over time. However, there are inadequate  data at the present time to provide firm guidance as to the optimal step-down approach. Therefore, clinicians will need to balance the benefits and risks associated with these therapies on an individual patient basis as they consider which patients should undergo step-down and which approach  would be most appropriate.
authors.affiliation: Department of Pediatrics, Washington University and St. Louis Children's Hospital, St. Louis, Missouri 63110, USA. bacharier_L@kids.wustl.edu
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Bacharier
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002985:Clinical Protocols; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D057285:Precision Medicine; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists