Assessing the Risks and Benefits of Step-Down Asthma Care: A Case-Based Approach

John B. Hagan, Matthew A. Rank

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


Guidelines have called for pharmacologic stepped care to improve asthma treatment. Therapeutic options which have been approved provide physicians and their patients alternatives for stepping up asthma treatment to achieve control. However, few studies have been performed to identify and characterize procedures for optimal stepping-down treatment in patients with asthma. The resulting uncertainty as well as a lack of prioritization for asthma reassessment once control has been maintained has led to a lack of well-defined procedures for stepping down asthma treatment. However, recent studies provide guidance regarding the risks of stepping down asthma medications. This review uses case-based examples to demonstrate how health care providers may engage patients in discussions regarding guideline recommendations to promote individualized asthma care.

Original languageEnglish (US)
JournalCurrent Allergy and Asthma Reports
Issue number4
StatePublished - 2015


  • Adherence
  • Asthma
  • Asthma control
  • Asthma guideline
  • Asthma monitoring
  • Bronchial hyperresponsiveness
  • Cost of care
  • Evidence-based medicine
  • Exacerbation risk
  • Exhaled nitric oxide
  • Forced expiratory volume at 1 s (FEV-1)
  • Forced vital capacity (FVC)
  • Individualized care
  • Inhaled corticosteroids (ICS)
  • Long-acting beta agonist (LABA)
  • Medication risk
  • Meta-analysis
  • Methacholine challenge
  • Pharmacotherapy
  • Sputum eosinophilia
  • Step down
  • Uncertainty

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine


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