Guidelines recommend that asthma treatment be stepped down to the minimally effective dose that achieves symptom control to prevent medication side effects and reduce unnecessary costs. Little is known about the practice of stepping down and the challenges in primary care, where most asthma patients are managed. This study’s objective was to explore views, experiences, barriers, and ideas of doctors, nurses, and pharmacists working in primary care related to the step down of asthma medication.
A total of 274 participants responded to the survey; 29 participated in an interview (12 doctors, 9 nurses, and 8 pharmacists), working in GP practices from across the UK. Nearly half of the survey participants infrequently step down asthma medication (doctors=42.7%, nurses=46.3%). Four major themes related to barriers to stepping down were:
- Lack of awareness of the need to step down,
- Inertia to step down, driven by low confidence in ability, fear of consequences, and concern for who is responsible for stepping down,
- Self-efficacy of ability to step down, influenced by lack of clear, applied guidance and limited training, and
- Feasibility of step down, driven by a lack of systematic acceptance of stepping down and time.
Strategies proposed to reduce overtreatment included education and training, and improved gathering of evidence and guidance, and integrating step down into routine asthma care.
Several contributing factors influence failure to implement this guideline recommendation into day-to-day asthma management. Future directions should include addressing evidence gaps, implementing clear and practical guidance, integrating step-down assessment into the asthma review, and educating professionals and patients.