HealthDay News — Asthma patients are increasingly prescribed higher levels of treatment, and few patients step down medications, according to a study published online July 21 in PLOS Medicine.

Chloe I. Bloom, Ph.D., from Imperial College London, and colleagues identified 508,459 adult asthma patients managed with preventer medication using nationwide U.K. primary care medical records for 2001 to 2017.

The researchers found that from 2001 to 2017, there was a steady increase in prescriptions of higher-level medication (medium/high-dose inhaled corticosteroids [ICSs] or ICSs + add-on medication) from 49.8 to 68.3 percent. One-third of those prescribed their first preventer were prescribed a higher-level medication; half of these patients had no reliever prescription or exacerbation in the previous year. During a mean follow-up of 6.6 years, 70.4 percent of patients first prescribed ICSs and one add-on remained on the same medication. In a cohort of 125,341 patients drawn to assess the impact of stepping down medication, 39,881 patients stepped down. No increased exacerbation risk was seen for each possible medication step-down and there was no increase in reliever prescriptions. Medication burden, but not medication side effects, was a prognostic factor to initiate step-down. Annual savings for stepping down medication, either long-acting β2-agonists or ICSs, were £17,000,000 or £8,600,000, respectively.

“Although stepping down of treatment is recommended by clinical guidelines, we found that it happened infrequently,” the authors write.


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Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text