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Stepping down asthma treatment: how and when.

Authors
Rogers-L; Reibman-J
Source
Curr Opin Pulm Med 2012 Jan; 18(1):70-75
NIOSHTIC No.
20040312
Abstract
PURPOSE OF REVIEW: Guidelines suggest that asthma medication should be reduced once asthma control is sustained. Moderate-dose inhaled corticosteroids (ICS) can typically be reduced, but questions remain about the lowest effective ICS dose and the role of non-ICS controllers in treatment reduction. Long-acting beta agonist (LABA) safety concerns have created controversy about how to step down patients on ICS/LABA therapy. This review will focus on the current status of these issues. RECENT FINDINGS: Intermittent ICS treatment, often in fixed combination with short-acting beta agonist, is an emerging strategy for control of mild asthma. Addition of leukotriene modifiers, LABAs, and omalizumab to ICS can allow for reduced ICS dosing. Doses of ICS that control symptoms may be inadequate to control exacerbations. Reducing ICS dose before discontinuing LABAs may be the more effective approach for patients on combination therapy. SUMMARY: Use of non-ICS controllers allows for ICS dose reduction with superior outcomes. Tapering of ICS prior to LABA discontinuation may be the favored approach for patients on ICS/LABA therapy, but an understanding of long-term outcomes and further safety data are required. The lowest ICS dose that adequately controls both asthma impairment and risk remains to be determined.
Keywords
Bronchial-asthma; Respiratory-system-disorders; Dose-response; Medical-treatment; Drugs; Pharmaceuticals; Control-methods; Corticosteroids; Drug-therapy; Medicinal-chemicals; Biological-effects; Author Keywords: asthma; inhaled corticosteroids; long-acting beta agonists; step-down
Contact
Linda Rogers, MD, FCCP, New York University School of Medicine, 550 First Avenue, New Bellevue 7N24, New York, NY 1006, USA
CODEN
COPMFY
Publication Date
20120101
Document Type
Journal Article
Email Address
linda.rogers@nyumc.org
Funding Type
Grant
Fiscal Year
2012
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-E11-OH-009630; B02292012
Issue of Publication
1
ISSN
1070-5287
Source Name
Current Opinion in Pulmonary Medicine
State
NY
Performing Organization
New York City Health and Hospitals Corporation
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