Decrease inhaled steroid dose by 50% after a period of asthma stability: risk of exacerbation remains low

The purpose of this meta-analysis (6 RTCs) was to estimate the risk of asthma exacerbation in stable asthmatics who reduce inhaled corticosteroids (ICS) compared to those who maintain a stable ICS dose.

The relative risk of an asthma exacerbation in individuals who reduced ICS compared to those who maintained the same ICS dose was 1.25 in studies with a mean follow-up of 22 weeks (5.5 months). Individuals who reduced ICS had a decreased% predicted FEV1 of 0.87% and a decreased mean morning peak expiratory flow of 9.57 l/min compared to those individuals who maintained a stable ICS dose.

Asthma exacerbations were statistically no more likely among individuals who reduced ICS compared to those who maintained their ICS dose, supporting current guidelines which recommend decreasing ICS by 50% after a period of asthma stability.



Asthma Treatment Options in 6 Steps (click to enlarge the image).

References:

The risk of asthma exacerbation after reducing inhaled corticosteroids: a systematic review and meta-analysis of randomized controlled trials. J. B. Hagan et al. Allergy, Article first published online: 26 FEB 2014 DOI: 10.1111/all.12368
http://onlinelibrary.wiley.com/doi/10.1111/all.12368/abstract