Q: I had a severe asthma flare that hospitalized me two years ago. My allergist boosted my asthma medication, and since then my symptoms have improved. I feel like I don’t need to take the medication as often anymore. How do allergists determine when it’s time to step down medication?
Cherie Zachary, MD: If you’re considering whether to step down or reduce daily asthma medication, your first step is to discuss it with your allergist. This is important – you should always talk with a healthcare professional before stopping any asthma medication.
Your allergist will want to sit down with you to ask questions and review your symptoms. Are you waking up at night because of your asthma? Are you experiencing symptoms related to exercise? How often do you refill your quick-relief bronchodilator inhaler?
If you’re waking up at night due to asthma more than twice a month, or if you’re experiencing chest tightness or difficulty breathing during or after exercise, or if you’re refilling your quick-relief inhaler more than two times per year, those are signs that stepping down your asthma medication is probably not the right thing to do.
However, if since your hospitalization you have not had any problems, you’re not waking up at night due to asthma, you’re keeping up with your normal activities and you haven’t had any emergency department or urgent care visits for asthma, that’s the time to see whether or not we can reduce your medication.
One thing I always do when reviewing medication with a patient is a lung function test. I want to make sure lung function has stayed stable, that it’s not gradually dropping. If your lung function is dropping, that’s another reason to say, ‘Wait a minute, we may not want to step down your asthma medication.’
Q: What should I share with my allergist as part of reviewing whether to step down medication?
Dr. Zachary: Review any lifestyle changes you have made with regard to any of your asthma triggers, such as environmental allergy exposures. For example, if you have a known allergy to a cat or dog, and you decide you want to bring a pet into your home, then we are going to have to review whether or not we really want to step down asthma medication.
If you don’t have any environmental allergy exposures, and you’re asthma is improving, that’s something to review and discuss with your allergist as well.
Should you and your allergist agree to step down medication, you will need to adjust your Asthma Action Plan so that you can closely monitor your condition in case asthma symptoms return when medication is stopped.
Cherie Zachary, MD, is a board-certified allergist and immunologist with Midwest Allergy and Asthma in Minneapolis, Minnesota and a member of the Board of Regents for the American College of Allergy, Asthma and Immunology.
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