As recognised in the British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guideline, decreasing treatment once a person’s asthma symptoms are controlled is recommended, but often not implemented, leaving some patients over-treated. NICE recommends that decreasing maintenance therapy can be considered when a person’s asthma has been controlled for at least three months. When deciding which drug to decrease first and how quickly, the following should be taken into account: 

When treatment is being decreased, they should be regularly reviewed and the dose reduced slowly as people deteriorate at different rates. Their PAAP should also be reviewed and updated in addition to updated advice on how to self-manage their asthma. The BTS/SIGN guideline suggests decreasing the dose by approximately 25–50 per cent each time and NICE states that stopping inhaled corticosteroid (ICS) treatment completely should only be considered for people who are only using low dose ICS as maintenance therapy, are symptom free and do not require their reliever inhaler. The benefits of ICS will wear off around four weeks after stopping and patients should be aware of monitoring for an exacerbation or deterioration in asthma control.