There are no objective indicators that are convincing enough to determine the optimal timing of step-down therapy. The decision to step-down therapy should be individualized and based on a comprehensive analysis of the drugs used, the dose, and the clinical response to achieve control. The risk factors for acute exacerbation should also be fully estimated, and a variety of factors, such as avoidance of triggers, should be considered to determine the step-down treatment plan.
When the inhaled hormone is a medium to high dose to achieve clinical control, it should take at least 3 months if it is reduced by 50% of the original dose, and the dose of inhaled hormone should generally not be less than the upper limit of the low dose group during the 3-month period (Table 1). Xin Jianbao, Department of Respiratory Medicine, Wuhan Union Medical College Hospital
Table 1 Doses and interchangeability of commonly used inhaled glucocorticoids
Commonly used hormones
Low dose (mg)
Medium dose (mg)
High dose (mg)
Beclomethasone dipropionate
200~500
500-1000
>1000-2000
Budesonide
200-400
400-800
>800-1600
Fluticasone Propionate
100-250
250-500
>500-1000
If clinical control can be achieved with the inhaled low dose group, treatment can be administered once a day. If asthma control is achieved with a combination of inhaled medium to high dose hormones and beta2 agonists, first consider reducing the dose of inhaled hormones while beta2 agonists are used sustainably, then consider discontinuing beta2 agonists and using inhaled hormones alone if asthma control can be achieved with low dose inhaled hormones. If the low dose inhaled hormone alone continues for one year without clinical manifestations such as recurrence of asthma symptoms, discontinuation of the drug can be considered for observation.