Stepping down asthma meds can control exacerbations, costs

Author(s):

A new study shows that qualified patients who decreased their asthma medications under physician supervision fared no worse than those that maintained their medication regimen.

Asthma management is expensive, but a new study reveals that stepping down asthma medications can be done safely and without any more complications than others with asthma face.

“In patients who have had stable asthma for at least one year, stepping down chronic asthma medications results in similar subsequent clinical outcomes compared to maintaining the same level of chronic asthma medications,” says lead author Matthew Rank, MD, and allergy and immunology specialist at the Mayo Clinic.

The study involved more than 4,000 asthma patients and found that 89.4% of the patients who reduced their asthma medication were able to control their condition compared to 83.5% who remained on their medication regimens.

The goal of asthma management, Rank notes in the study, is to control symptoms and prevent exacerbations with the least amount of medication possible. The step down can result in a decrease in side effects, as well as cost savings, without negative outcomes.

“Stepping down asthma medication is associated with a significant cost savings ($34 per month) and does not result in an increase in emergency department visits, hospital visits, outpatient visits, or missed work/school days,” Rank told Medical Economics. “We believe that the results of this study should make health care providers feel more comfortable in talking with their patients about the risks of stepping down chronic asthma medications.”

Patients involved in the study that stepped down their asthma medications with the aid of their physician did not miss any more school or work, or visit the emergency department with exacerbation any more than asthma patients who maintained their medication regiments. Patients who decreased their medications without physician assistance and regardless of their eligibility, however, had a 56% increase in missed work and school, according to the report.

Eligibility for medication step down was determined if they had no hospitalizations or emergency department visits for asthma exacerbation over a period of about 14 months, if they had used three or less rescue inhalers over the same period, or if they were already at their lowest possible level of medication.

“This suggests that stepping down asthma medications in those who are not eligible leads to increased indirect costs and should be approached with caution,” according to the report.

A 2012 report published in Current Opinion in Pulmonary Medicine also tackled the topic of medication step down, noting that medications should be reduced once asthma control is achieved and maintained. The study authors recommended taped decreases in inhaled corticosteroids and long-acting beta agonists for the best outcome. The study, however, was unsuccessful in achieving its goal of determining the lowest possible inhaled corticosteroid dose that would still control asthma impairment.