Stepping down inhaled corticosteroids in asthma: randomised controlled trial.

OBJECTIVES To determine whether the dose of inhaled corticosteroids can be stepped down in patients with chronic stable asthma while maintaining control. DESIGN One year, randomised controlled, double blind, parallel group trial. SETTING General practices throughout western and central Scotland. PARTICIPANTS 259 adult patients with asthma receiving regular treatment with inhaled corticosteroids at high dose (mean dose 1430 microg beclomethasone dipropionate). INTERVENTIONS Participants were allocated to receive either no alteration to their dose of inhaled corticosteroid (control) or a 50% reduction in their dose if they met criteria for stable asthma (stepdown). MAIN OUTCOME MEASURES Comparison of asthma exacerbation rates, asthma related visits to general practice and hospital, health status measures, and corticosteroid dosage between the two groups. RESULTS The proportions of subjects with asthma exacerbations were not significantly different (stepdown 31%, control 26%, P=0.354). Similarly, the numbers of visits to general practice or hospital and the disease specific and generic measures of health status over the one year period were not significantly different. On average the stepdown group received 348 microg (95% confidence interval 202 microg to 494 microg) of beclomethasone dipropionate less per day than the controls (a difference of 25%), with no difference in the annual dose of oral corticosteroids between the two treatment regimens. CONCLUSIONS By adopting a stepdown approach to the use of inhaled steroids at high doses in asthma a reduction in the dose can be achieved without compromising asthma control.