Comparative safety and costs of stepping down asthma medications in patients with controlled asthma.
Limited data exist regarding outcomes after stepping down asthma medication.



We sought to compare the safety and costs of stepping down asthma controller medications with maintaining current treatment levels in patients with controlled asthma.



Patients with persistent asthma were identified from the US Medical Expenditure Panel Survey years 2000-2010. Each patient had Medical Expenditure Panel Survey data for 2 years, and measurement was divided into 5 periods of 4 to 5 months each. Eligibility for stepping down asthma controller medications included no hospitalizations or emergency department visits for asthma in periods 1 to 3 and no systemic corticosteroid and 3 or less rescue inhalers dispensed in periods 2 and 3. Steps were defined by type and dose of chronic asthma medication based on current guidelines when comparing period 4 with period 3. The primary outcome of complete asthma control in period 5 was defined as no asthma hospitalizations, emergency department visits, and dispensed systemic corticosteroids and 2 or fewer dispensed rescue inhalers. Multivariable analyses were conducted to assess safety and costs after step down compared with those who maintained the treatment level.



Overall, 29.9% of patients meeting the inclusion criteria (n = 4235) were eligible for step down; 89.4% (95% CI, 86.4% to 92.4%) of those who stepped down had preserved asthma control compared with 83.5% (95% CI, 79.9% to 87.0%) of those who were similarly eligible for step down but maintained their treatment level. The average monthly asthma-related cost savings was $34.02/mo (95% CI, $5.42/mo to $61.24/mo) with step down compared with maintenance of the treatment level.



Stepping down asthma medications in those whose symptoms were controlled led to similar clinical outcomes at reduced cost compared with those who maintained their current treatment level.
Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn. Electronic address: rank.matthew@mayo.edu.
Matthew A
MA
Rank
Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn.
Juliette T
JT
Liesinger
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minn.
Megan E
ME
Branda
Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minn; Mayo Graduate School, Rochester, Minn.
Michael R
MR
Gionfriddo
Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
Michael
M
Schatz
Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
Robert S
RS
Zeiger
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minn.
Nilay D
ND
Shah
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000191:economics / Q000627:therapeutic use; D016859:Lipoxygenase Inhibitors / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists; D016859:Lipoxygenase Inhibitors
Asthma; anti-inflammatory agents; antiasthma agents; de-escalate; health services; reduce; step down; taper; withdraw