Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: A population-based observational study

This analysis found asthma patients were increasingly prescribed higher levels of treatment, often without clear indication. Stepping down (dropping LABA /other add-on or halving ICS dose) was not associated with an increase in exacerbations or reliever prescriptions.

SPS commentary:

The authors noted that stepping down medication occurred infrequently, with 70.4% of those first prescribed ICS plus one add-on remaining on the same mediation during a mean follow-up of 6.6 years. In addition there was no evidence that those experiencing common ICS side-effects, diabetes, and cataracts, were preferentially stepped down. Based on a number of assumptions it is estimated that stepping down LABAs from half of the UK’s stable adults treated with LABA-ICS would result in an annual saving of approximately £17,000,000. The respective annual saving for ICS step-down is estimated as £8,600,000.

PLOS Medicine