Current guidelines advocate stepping-down inhaled corticosteroid (ICS) therapy at 3-monthly intervals once asthma control has been achieved. Despite this, there are no data describing how widespread the practice of reducing ICS therapy is, especially in secondary care.
We assessed patients with asthma being followed up in a secondary care respiratory clinic for a minimum period of 6 months. Patients who were actively receiving or had received either oral or parenteral corticosteroids, or immunosuppressive therapy within a 12-month period were excluded. Patients were also required to be exacerbation-free during this period. A retrospective study was performed over the preceding 12 months in order to evaluate whether ICS therapy had been reduced or not following a prolonged period of stability.
60 consecutive patients with asthma were assessed in clinic. 12 patients with mean age of 56 years and forced expiratory volume in 1 second of 1.97L (73% predicted) completed the study. The mean beclomethasone dipropionate (BDP) equivalent ICS daily dose was 1267μg and patients had either moderate (n = 6) or severe (n = 6) asthma. Only two patients had step-down in ICS therapy. One patient had a 33% reduction in ICS dose from an initial daily dose of BDP 1500μg, having had stable asthma for 11 months. The other patient had a 50% reduction in ICS dose from an initial daily dose of fluticasone propionate 1000μg, having had stable asthma for 8 months. The remaining 10 patients continued on the same dose of ICS despite having had stable asthma during the preceding 12 months. There were no significant differences in any outcomes according to whether patients had ICS therapy reduced or not.
Our preliminary data have shown that stepping-down ICS therapy in patients with stable asthma is being poorly implemented.
If this is reflective of practices throughout the United Kingdom, many patients with stable asthma may be exposed to unnecessary high doses of ICS.
Daniel Lee, None.