A Mayo Clinic study published in 2015 found that a lot of people with well-controlled asthma can safely cut back on their medication use without seeing an uptick in symptoms. In the study, nearly 90% of adults and children who stepped down their meds continued to have control over their symptoms, about the same rate as people who maintained control without stepping down.
The benefits of being able to do this safely are big. In general, people taking less medicine have a lower risk of side effects. Plus, taking less asthma medicine saves money because you don't buy as many drugs or need extra doctor or hospital visits—an average savings of $34 a month (that's $400 a year!), the study found. While this may sound like a win-win, it isn't a risk-free process.
What does "stepping down" mean?
If your asthma symptoms are under control for at least 3 months, your doctor may want to decrease—or step down—your drug doses. You may be able to take some drugs just once a day, stop taking a drug or switch to a different drug.
How do I step down?
Some people try to cut back on their own, but this is a huge no-no. Stopping your meds suddenly or without your doctor's guidance can lead to very serious side effects, like hormone problems and even death. Stopping corticosteroids all at once may give you withdrawal symptoms, like vomiting, fatigue, joint and muscle pain, scaly skin, weight loss, and dangerously low blood pressure.
As with any treatment changes, you should talk to your doctor to find the best doses for your needs. The big question will be: Do you step down your steroid or one of your other control meds, like your long-acting beta agonist? Each drug has its own potential risks, explains Stephen Wasserman, MD, professor of medicine in the division of Rheumatology, Allergy & Immunology at UCSD. That's why every treatment plan must be individualized for each patient, Dr. Wasserman adds.
Any tweaks to your treatment will probably be done slowly over time, especially if you've been on the same meds for a while.
After stepping down, you'll need to closely monitor your symptoms to make sure they don't get worse. If they do, you may need to "step up" again. You may also still need to take a corticosteroid if you get sick or need surgery.
Who shouldn't step down?
It may not be possible to step down your asthma meds if you:
- Are pregnant or planning to become pregnant
- Have a respiratory infection
- Are traveling
- Simply don't want to
That last one may seem obvious, but you shouldn't feel pressured (by your family, friends, doctor, etc.) to start cutting down on your medication if you're happy with your current treatment plan. Some people in your life may think asthma is a psychological illness and not a physical disease that requires real treatment, Wasserman says. "If you need medicine, you need it," he says. "It's not a sign of weakness."
He adds that your treatment plan should allow you to live life to the fullest. And with your doctor's help, you may be able to cut back on the amount of medicine you need to do that.
