Update on asthma step-therapy

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The 2007 NAEPP guidelines elegantly outline an evidence-based stepwise approach to evaluate, attain, and sustain asthma control. A conceptual paradigm shift in the 2007 guidelines is the focus on achievement of current asthma control to minimize future risk. Recently, the Food and Drug Administration (FDA) has revoiced concerns regarding asthma pharmacotherapy-related safety issues. In particular, they give guidance on stepping down of asthma therapy after control is achieved. Unfortunately, there are no published randomized controlled trials addressing this question, and current National Asthma Education and Prevention Program recommendations on this topic are evidence category D. This manuscript reviews some of the recent studies published since release of the Expert Panel Report 3 and FDA warnings that may add to our understanding of this issue.

Keywords: Asthma control; asthma control measures; biomarkers; inhaled corticosteroids; leukotriene modifiers; long-acting beta2 agonists; step-up/step-down therapy

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/aap.2010.31.3395

Affiliations: Children’s Mercy Hospital, Kansas City, Missouri, USA

Publication date: November 1, 2010

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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