The Conversation I Love to Have with Parents about Asthma
May 11, 2021
Nothing stays the same, including your child’s asthma. We know that asthma is a chronic disease. Symptoms and severity may change from season to season, month to month, or even year to year. This is why to better manage your child’s asthma, I have to continuously assess if it is well controlled. By determining how often your child is having symptoms or needing to use the rescue inhaler, we can then make medication adjustments.
Classically, stepping UP asthma therapy has been the focus, and may be a conversation that you have had with your child’s doctor at some point along the way. This involves advancing medications in cases where your child’s asthma is inadequately controlled. We have guidelines to help us do this, which include options such as increasing dose, changing to a new daily controller medication, or adding on another medication to the current plan. But what about stepping DOWN therapy? Although this may not be in the spotlight quite as much, it is certainly my most favorite conversation to have!
What Is It?
Stepping down therapy is just as the name suggests. It is a reduction in the amount of medication that your child takes to control their asthma symptoms. This may take different forms depending on what medications they are on, such as decreasing dose or stopping a medication altogether.
Why Do It?
The goal of asthma therapy is to control the disease with the minimum amount of medication required. Most importantly, decreasing medication will serve to minimize any potential harmful effects from taking more medication than is actually needed. Aside from this, stepping down therapy will also simplify your child’s treatment plan, hopefully making your day-to-day routine a bit easier. Families may also benefit from a financial standpoint with fewer medications, meaning fewer costs.
In general, patients who have been controlled for at least 3-6 months can be considered. I would never want to step down therapy for anyone with a recent serious flare. There are other factors to consider as well, such as your child’s triggers and pattern of symptoms. For example, if your child has allergic asthma that primarily flares in the spring, stepping down therapy in April would not be ideal. Each patient’s asthma is unique, so I have to take into consideration all of the nuances including severity, triggers, current or future exposures, and difficulty achieving control in the first place. It is certainly not a one-size-fits-all approach!
If you feel that your child might qualify or if you have additional questions, I encourage you to talk with your pediatrician or asthma specialist. Stepping down therapy, and asthma management in general, is a team approach that involves shared-decision-making between you and your doctor. Just remember- as important as it is to make changes when things are not going well, it is just as important to adjust when things are!
If you would like more information about the Asthma Program at Nationwide Children’s Hospital, click here or call (614) 722-4766.
Kasey Strothman, MD is an assistant professor of pediatrics in the Division of Allergy and Immunology. Dr. Strothman is board-certified in allergy and immunology, and a fellow of the American Academy of Allergy, Asthma and Immunology. In 2020 she became director of the Complex Asthma Clinic at Nationwide Children’s Hospital.
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