Stepping-down asthma controller therapy displayed noninferiority to the maintenance of therapy in patients with asthma who had been stable with low-dose inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) for at least three months, concluded a trial published in "The Journal of Allergy and Clinical Immunology". Investigators compared the two kinds of step-down approaches for the maintenance of treatment.

This three-arm parallel, open-label, pragmatic randomized controlled trial enrolled a total of 225 participants (age 18 years or older) that were randomly divided into three groups:

• Group 1 (G1): Maintenance on low-dose ICS/LABA
• Group 2 (G2): Discontinued LABA
• Group 3 (G3): Reduced ICS/LABA to once daily and were followed for six months.

The primary outcome was an alteration in asthma control test scores between randomization and the final six-month follow-up. In the per-protocol population, alteration in the asthma control test was analyzed.  As compared with the maintenance group, the non-inferiority was not illustrated in either of the step-down group. In the step-down groups, a greater rate of therapeutic failure was noted (although about 90% of patients were fine).

No vital differences between the step-down approaches were witnessed in terms of asthma control test change or therapeutic failure. The step-down strategy may be undertaken when the asthma patients are stable. However, adequate monitoring and supervision are crucial with precautions regarding the loss of disease control, concluded the authors.