Asthma symptoms can change over time. They may grow milder or more severe. Sometimes, new symptoms can appear, or symptoms can disappear altogether.
When symptoms change, a healthcare provider (HCP) will adjust treatment in response. If symptoms worsen, an HCP may increase or “step up” medication. If symptoms improve and are well-controlled, an HCP may be able to reduce or “step down” medication.
There are benefits to stepping down safely. These include the following:
- It lowers the risk of side effects.
- It may become easier to take your medication as directed.
- You could save money.
- You may not need to visit an HCP as often.
Stepping down isn't a risk-free process, however. Here’s what to know.
How does stepping down happen?
To step down, asthma symptoms must be under control for three to six months, depending on how severe they were when you began treatment. If they have mostly been controlled but you’ve had a serious asthma flare recently, stepping down may not be recommended.
When you step down, you may be able to take some drugs just once a day, stop taking a drug, or switch to a different drug. The goal is using the least amount of medication necessary to control your symptoms effectively.
How do I step down?
Never try to step down on your own. Stopping medications suddenly or without an HCP’s guidance can lead to serious side effects, such as asthma attacks, asthma emergencies, or even death. If you use a corticosteroid inhaler, stopping its use may result in withdrawal symptoms, including vomiting, fatigue, joint and muscle pain, and dangerously low blood pressure.
As with any treatment changes, talk to your HCP about your wants and needs. Any tweaks to your treatment will probably be made slowly over time, especially if you've been on the same medications for a while. Every treatment plan must be individualized for each patient, explains Stephen Wasserman, MD, emeritus professor of medicine in the Division of Rheumatology, Allergy & Immunology at UCSD in San Diego.
After stepping down, closely monitor your symptoms to make sure they don't worsen. If they do, you may need to "step up" again. You may also still need to take a corticosteroid if you become sick or need surgery.
Who shouldn't step down?
It may not be possible to step down your asthma medication if you:
- Are pregnant or planning to become pregnant
- Have a respiratory infection
- Are traveling
- Simply don't want to
You shouldn't feel pressured by your family, friends, or HCP to cut back on 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. With your HCP’s help, you may be able to cut back on the amount of medicine you need to do that.
Sources: Asthma and Allergy Foundation of America... + 7
- Asthma and Allergy Foundation of America. Asthma in Adults. July 2024.
- Cleveland Clinic. Asthma Controller Therapy: When to Consider Stepping Down. March 4, 2019.
- American Academy of Allergy, Asthma, and Immunology. Follow the Stepwise Approach for Asthma Control. October 31, 2023.
- Better Health Channel (AUS). Asthma medication. February 8, 2023.
- NHS (UK). Steroid inhalers. April 19, 2023.
- Nemours Kids Health. What if Kids Don't Take Their Asthma Medicine? September 2017.
- American Academy of Allergy, Asthma, and Immunology. Asthma and Pregnancy. October 31, 2023.
- Reddel HK, Foxley GJ, Davis SR. How to step down asthma preventer treatment in patients with well-controlled asthma - more is not always better. Aust Prescr. 2022 Aug;45(4):125-129.
