CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Asthma - Management
Children and adults with controlled symptoms on current treatment: How do I manage?
- Do NOT step down treatment for people who have ongoing symptoms or need inhaled short-acting beta2-agonists, and those who have had a recent exacerbation.
- If a person has controlled symptoms, consider the following approach to step-down treatment:
- Make sure the person feels that their asthma is controlled and that they are willing to try step-down treatment.
- Reduce the dose of inhaled corticosteroids slowly. The usual protocol is to decrease the dose by 25% to 50% per 3-month visit. Explain the potential for worsening symptoms and the increased risk of an exacerbation.
- Some children with milder asthma and a clear seasonal pattern to their symptoms may tolerate a more rapid dose reduction during their 'good' season.
- Review the person on a regular basis; promote lifestyle advice, assess for worsening symptoms, and consider increasing medication if the person's asthma deteriorates.
- If stepping down is not possible, and the person is stable on an inhaled corticosteroid and a long-acting beta2-agonist, consider prescribing a combination inhaler.
In depth
© NHS Institute for Innovation and Improvement