Decreasing maintenance therapy

1.10.1 At annual review discuss with the person with asthma (or their family or carer, if appropriate) the potential risks and benefits of decreasing their maintenance therapy when their asthma has been well controlled on their current maintenance therapy.

[NICE 2017, BTS/SIGN 2019, amended BTS/NICE/SIGN 2024]

1.10.2 When decreasing maintenance therapy:

• Stop or reduce dose of medicines in an order that takes into account the clinical effectiveness when introduced, side effects and the person's preference.
• Allow at least 8 to 12 weeks before considering a further treatment reduction.
• If considering step-down treatment for people aged 12 and over who are using low-dose maintenance inhaled corticosteroid (ICS) plus a short-acting beta₂ agonist (SABA) as needed or low-dose MART (maintenance and reliever therapy), step down to low-dose ICS/formoterol combination inhaler as needed (as-needed AIR therapy).

[NICE 2017, BTS/SIGN 2019, amended BTS/NICE/SIGN 2024]

1.10.3 Agree with the person (or their family or carer if appropriate) how the effects of decreasing maintenance therapy will be monitored and reviewed, including self-monitoring and follow-up with a healthcare professional.

[NICE 2017]

1.10.4 Review and update the person's asthma action plan when decreasing maintenance therapy.

[NICE 2017]