ArticleThe journal of allergy and clinical immunology. Global2026
Self-directed de-escalation of maintenance inhaler therapy in patients with severe asthma in remission with biologic treatment: An observational study.
Article in The journal of allergy and clinical immunology. Global, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: mAbs targeting type 2 inflammation have significantly improved disease control in severe asthma. As more patients achieve clinical stability, the safety and outcomes of maintenance inhaled therapy (MIT) de-escalation have become clinically relevant. Although guidelines support personalized treatment and cautious MIT reduction in patients whose severe asthma is well controlled, the real-world evidence remains limited. Objectives: Our aim was to evaluate whether clinical stability can be maintained following the voluntary de-escalation of MIT by patients with severe eosinophilic asthma who are undergoing treatment with biologics. Methods: We conducted a single-center retrospective study of severe asthmatic individuals treated with biologics for at least 24 months. Patients were classified into 2 groups: those who voluntarily reduced their MIT (the de-escalation group [DG]) and those who maintained treatment (the control group). De-escalation was defined as any reduction in medication intensity involving an inhaled corticosteroid, long-acting β-agonist, or long-acting muscarinic antagonist, meaning a decrease in inhaled corticosteroid dose and/or discontinuation of long-acting muscarinic antagonist or long-acting β-agonist and long-acting muscarinic antagonist. Data on asthma control, lung function (based on FEV Results: The records of 40 patients were examined. At T2, 40% (n = 16) had de-escalated MIT and 67.5% (n = 27) had achieved complete clinical remission, including 13 in the DG. No patients in the DG required treatment escalation or experienced asthma exacerbations. After adjustment for baseline differences, the DG maintained modestly higher Asthma Control Test scores, whereas no significant difference was observed in thier FEV Conclusion: MIT de-escalation in patients with severe asthma treated with a biologic appears feasible and safe. These data support consideration of MIT de-escalation as an additional component of complete clinical remission.
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