Patients with stable asthma are keen to ‘step down’ their medication when appropriate, say researchers who surveyed general practice patients across England.

It follows another recent study from the same team who found moderate to high doses of inhaled corticosteroids are associated with an increased risk of cardiovascular events, pulmonary embolism, and pneumonia.

Yet evidence shows that patients are rarely ‘stepped down’ on asthma medication once their symptoms are under control.

Speaking with our sister title Pulse, researcher Dr Chloe Bloom, an honorary consultant in respiratory medicine at Imperial College Healthcare NHS Trust, said the results should ‘reassure’ healthcare professionals that patients are happy to have their medication reduced.

‘I’d interviewed healthcare professionals before, and there was some resistance to stepping down because of various reasons, one of which was that they were worried what the patients would think,’ she explained.

To investigate further she surveyed 143 patients with stable asthma from across the country aged between 18 and 80 years. More than 60% were female.

Half of them had never had a discussion about stepping down asthma medication despite having the condition for 10 years or more.

The research showed that patients were able to self-manage their asthma well, but they had little awareness of adverse effects related to their medicines.

Most were inclined to step down, if clinically safe to do so, indeed some had reduced their medication doses themselves, without professional guidance, Dr Bloom and colleagues reported in BMJ Open Respiratory Research.

Ultimately fears over whether patients would be willing should not be a barrier to stepping down asthma medication and reduce overuse, they concluded.

Dr Bloom said: ‘These were patients who were very stable but had been on inhaled steroids for a number of years so I thought they might not be that interested in stepping down but they mostly were.’

Until recently there had not been much guidance for primary care on how to go about stepping down asthma medication so it was perhaps not surprising this did not happen much, she explains.

But the long-awaited joint NICE/SIGN/BTS guidelines published in November now makes it really clear how to do this, she adds.

With the move towards anti-inflammatory reliever therapy (AIR) and Maintenance and Reliever Therapy (MART) with a stepwise approach to prescribing, there is now good guidance for healthcare professionals on how to do it, she adds.

‘Patients themselves can do it because it’s part of MART and AIR. So that’s amazing. So for new people starting on the new guideline, that will be resolved, but there’s still a whole lot of people out there who are still going to be treated on the previous guidelines.’

She added: ‘Patients want to do this. Everyone is aware that patients don’t want to be taking tablets they don’t need but there’s somehow a bit of a disconnect when it’s an inhaler.’

The guidelines can also give clinicians the confidence that people do not need very high doses of inhaled corticosteroids and if they do need that they need to be referred to a specialist, she said.

But the interviews with asthma patients also highlighted that a lot were not having face to face asthma reviews and had perhaps received a text about their symptoms.

‘Patients did want to speak to someone, at least over the phone and ideally in person and that is the time when you can have these conversations about stepping down and self-management.’

This article was originally published by our sister title Pulse