PRACTICE RECOMMENDATIONS
Chronic stable asthma patients who use at least 1000 μg beclomethasone or its equivalent daily may reduce their dose of inhaled corticosteroids by as much as 50% without compromising control of symptoms.
Q&A
Tapering inhaled steroids effective for chronic asthma
- BACKGROUND: Asthma management guidelines recommend a reduction in steroid use once control is obtained. While some evidence shows that this approach is effective in mild disease, the approach had not been tested long-term in people with moderate to severe disease.
- POPULATION STUDIED: A total of 259 adult participants were recruited from rural and urban general medical practices in Scotland. They had an asthma diagnosis for 1 year or more, and daily treatment with at least 800 μg beclomethasone dipropionate, fluticasone, or budesonide equivalent. Eighty-two percent of patients completed the study.
- STUDY DESIGN AND VALIDITY: In this long-term, randomized, double-blind trial, patients received either beclomethasone or fluticasone at the dose used before the study began. After this run-in period, they were randomized to receive either a reduction in their dose of inhaled steroids (step-down) or a sham reduction.
- OUTCOMES MEASURED: The primary objective was to compare the rates of asthma exacerbation over 1 year. Other outcomes included the number of general practice visits, hospital admissions, and the proportion of patients receiving a 50% reduction in the dose and health status.
- RESULTS: At various points during the study, 84% of the step-down group met adequate control criteria and they were given a reduction in the inhaled steroids. Of that group, 49% of the patients achieved a 50% reduction in their dose while maintaining good asthma control. No significant difference was found in the rate of asthma exacerbation or events between the 2 groups. Thirty-one percent (40 people) in the step-down group and 26% (33 people) in the control group had an exacerbation requiring oral steroids (odds ratio [OR]=1.29; 95% confidence interval [CI], 0.75–2.23; P=.354). Overall, the results showed no significant difference in the annual dose of oral steroids between the groups.