Similar clinical outcomes at reduced costs were observed in patients stepping down their asthma medications whose symptoms were controlled compared with those who maintained their current treatment level, according to a study of 4,235 patients with persistent asthma. Study findings included:

• 30% of patients meeting the inclusion criteria (n=4,235) were eligible for step down.

• 89.4% of patients who stepped down had preserved asthma control compared with 83.5% of those who were similarly eligible for step down but maintained their treatment level.

• Average monthly asthma-related cost savings was $34 per month with step down compared with maintenance of the treatment level.

Citation: Rank MA, Liesinger JT, Branda ME, et al. Comparative safety and costs of stepping down asthma medications in patients with controlled asthma. [Published online ahead of print October 21, 2015]. J Allergy Clin Immunol. doi: 10.1016/j.jaci.2015.08.035.

Commentary: This is an interesting study, supporting the recommendation to step down therapy in patients whose asthma is well-controlled and who have not had either ER visits or needed doses of oral corticosteroids. Since this is a large database study, it is subject to confounders, and we don’t know if patients who received step-down treatment had other characteristics that might have influenced their physicians to attempt step down therapy. When all is said and done, step down therapy for patients with well controlled asthma is recommended in the current guidelines, makes clinical sense, and is supported by the results of this study. —Neil Skolnik, MD