When you stop taking low-dose inhaled corticosteroids (ICS) inhalers, researchers have shown that this can have serious consequences to your wellbeing, as it more than doubles your risk of exacerbation. According to study lead Dr Matthew Rank, allergy and immunology physician in Minnesota, for every five patients with asthma whose ICS were stopped, one would suffer an exacerbation.
For the study, researchers examined the data of 1040 patients across seven randomised controlled trials where inhaled corticosteroids were stopped. Each of these seven trials had at least four weeks of a run-in period with a stable dose of inhaled corticosteroids, in order to ensure a minimum period of asthma stability while part of the trial, and the trials lasted for 12 to 52 weeks. This is the first review and meta-analysis to examine the wellness risk of asthma exacerbation in patients who stop low-dose inhaled corticosteroids.
The results were that children have an 80% increased risk of exacerbation, whilst adults are more than two-and-a-half times more likely, compared with patients who continued taking ICS. People who stopped medication also demonstrated an average decrease in FEV1 of 130mL. According to Rank, ‘These results should guide discussions between patients with stable asthma and their health care providers regarding the risks and benefits of stopping low-dose inhaled corticosteroids.’
Professor Mike Thomas, a Gloucestershire GP and chief medical advisor for Asthma UK, argued that GPs and nurses need to inform patients about the increased risk of asthma attacks when stopping inhaled corticosteroids, saying ‘This confirms that low doses of ICS are extremely effective at preventing exacerbations and controlling symptoms for people with persistent asthma, but are not a cure, and for most people asthma is a long term condition.’
According to the current BTS/SIGN guidelines on asthma, you should be considering reducing your inhaler dose every three months. This means that you will be reducing the dose by approximately 25% to 50% each time. Thomas said, ‘Sometimes people are so well controlled that they are tempted to stop taking treatment – some may be able to do this, but need to be informed about asthma attacks or returning symptoms if they choose to do so.’
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