Clinical Question: Can the dosage of corticosteroids in patients with chronic stable asthma be reduced while still maintaining control?
Setting: Outpatient (primary care)
Study Design: Randomized controlled trial (double-blind)
Synopsis: Researchers enrolled 259 adults from general practices in Scotland. Participants had a history of asthma and were being treated with at least 800 mcg of inhaled beclomethasone per day (average dosage: 1,430 mcg per day) for asthma treatment or an equivalent dosage of other inhaled steroids. The patients had stable asthma, which was defined as not requiring oral corticosteroids or request for asthma treatment in the previous two months.
The participants were randomly assigned to receive a full dosage or a reduced dosage (50 percent) of their steroid. At the start of the study, patients in both groups received their usual dosage. At follow-up visits, their clinicians were given a packet with two inhalers, one labeled “usual dosage” and the other labeled “reduced dosage,” with instructions to choose the appropriate inhaler based on the clinical control of the patient. In the control group, however, the “reduced dosage” inhaler actually was the usual dosage. Clinical control was assessed by evaluating twice-daily peak expiratory flow measures recorded by patients for the previous two weeks.
During the course of the study, 81 to 84 percent of the patients in both groups were in good control and had been given the reduced-dosage inhaler. By the end of the study, 49 percent of patients in the step-down group were taking the lower dosage. No differences in asthma exacerbations existed between the two groups, and there was no difference in health status measures or asthma morbidity scores.
Bottom Line: Adult patients with asthma whose dosages have increased can, once their asthma is under control, reduce the dosage by one half without experiencing changes in control for at least one year. (Level of Evidence: 1c)