Outcomes of stepping down asthma medications in a guideline-based pediatric asthma management program

Matthew A. Rank, Megan E. Branda, Deborah B. McWilliams, Shirley K. Johnson, Shefali A. Samant, Jenna C. Podjasek, Miguel A. Park, Gerald W. Volcheck

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Little is known about outcomes after stepping down asthma medications within an asthma management program. Objective: To determine outcomes of stepping down asthma medications in a pediatric asthma management program. Methods: We performed a retrospective study of 5- to 18-year-old children with asthma in an integrated primary care practice in the United States. Data were included on participants from March 1, 2009, until December 31, 2011. We first determined whether a child was eligible for step down and next recorded whether a step-down attempt was made and if the attempt was successful. In addition to descriptive statistics for the sample demographics and the outcomes of stepping down, univariate and multivariate analyses were performed to determine predictors of successful asthma medication step-down attempts. Results: Of the 477 children sampled for this study, 264 (55.3%) had a guideline-eligible opportunity to step down asthma medications. An attempted step down occurred in only 89 (33.7%) of children who had guideline-eligible opportunities. A total of 166 children (34.8%) attempted a step down of asthma medication at least once (including those guideline ineligible to step down). Of children with follow-up, 96 (71.6%) of step-down attempts were successful. Time of year (any season except fall) when the step down was attempted predicted successful step down in univariate and multivariate analysis (odds ratio = 3.81; 95% confidence interval, 1.23-11.85; P =.02). Being guideline eligible for step down predicted successful step down in univariate analysis only (odds ratio = 2.51; 95% confidence interval, 1.16-5.43; P =.02). Conclusion: Our findings from this sample of children participating in an asthma management program suggest that stepping down asthma medication based on National Asthma Education and Prevention Program 3 guidelines is frequently successful.

Original languageEnglish (US)
Pages (from-to)354-358.e2
JournalAnnals of Allergy, Asthma and Immunology
Issue number5
StatePublished - May 2013

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine


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