{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T13:34:25Z","timestamp":1767792865911,"version":"3.49.0"},"reference-count":17,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T00:00:00Z","timestamp":1738540800000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["301726"],"award-info":[{"award-number":["301726"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2024,12,5]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"\n Background<\/jats:title>\n Guidelines recommend that asthma medication should be stepped down to the minimally effective dose that achieves symptom control. Stepping down aims to prevent adverse medication effects and unnecessary costs but is often not implemented in primary care, where most patients with asthma are managed. Little is known about the experiences and views of patients regarding stepping down.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients with stable asthma, with regular use of a preventer inhaler, from general practitioner practices across England, participated in a survey and\/or semi-structured interview. Questions explored the patient\u2019s understanding of their asthma, views and knowledge of preventer inhalers, experiences and perceptions of stepping down asthma medication. Qualitative group-based multidisciplinary thematic analysis by two healthcare professionals and a patient were performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 143 patients responded to the survey, 63% were female, between the ages 18\u201380 years and including geographical areas across the UK, 17 of whom participated in an interview. Half of these patients with stable asthma, most with asthma for more than 10 years, had never had a discussion regarding stepping down asthma medication. Most stepping down that had occurred was related to seasonal changes in asthma control. Four overarching themes from the interviews were identified, (1) experiences of living with asthma and needing inhalers, (2) insufficient education regarding preventer inhalers, (3) stepping down is agreeable and possible and (4) current asthma care is suboptimal.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Patients with stable asthma were able to self-manage their asthma well. They had little awareness of medication adverse effects and minimal experience of having their medication stepped down by a healthcare professional. Most were inclined to step down, if clinically safe to do so, indeed some had reduced their medication doses themselves, without professional guidance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjresp-2024-002898","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T10:00:12Z","timestamp":1738576812000},"page":"e002898","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1285-7602","authenticated-orcid":false,"given":"Chloe I","family":"Bloom","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Middleton","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0576-8823","authenticated-orcid":false,"given":"Adam","family":"Lewis","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Southampton, London, UK"},{"name":"Brunel University, Brunel University London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"2026010701501363000_12.1.e002898.1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02130-2018","article-title":"Changing prevalence of current asthma and inhaled corticosteroid treatment in the UK: population-based cohort 2006-2016","volume":"53","author":"Bloom","year":"2019","journal-title":"Eur Respir J"},{"key":"2026010701501363000_12.1.e002898.2","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/02770903.2019.1672723","article-title":"Inadequate specialist care referrals for high-risk asthma patients in the UK: an adult population-based cohort 2006-2017","volume":"58","author":"Bloom","year":"2021","journal-title":"J Asthma"},{"key":"2026010701501363000_12.1.e002898.3","unstructured":"British Thoracic Society . BTS\/sign british guideline on the management of asthma. 2019."},{"key":"2026010701501363000_12.1.e002898.4","unstructured":"National Instititute for Clinical Excellence . Asthma: diagnosis, monitoring and chronic asthma management. 2017."},{"key":"2026010701501363000_12.1.e002898.5","unstructured":"Global Initiative for Asthma . Global strategy for asthma management and prevention. 2023."},{"key":"2026010701501363000_12.1.e002898.6","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2147\/JAA.S274943","article-title":"Qualitative Study of Practices and Challenges of Stepping Down Asthma Medication in Primary Care Across the UK","volume":"13","author":"Bloom","year":"2020","journal-title":"J Asthma Allergy"},{"key":"2026010701501363000_12.1.e002898.7","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2018-212957"},{"key":"2026010701501363000_12.1.e002898.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2020-000756","article-title":"Systemic adverse effects from inhaled corticosteroid use in asthma: a systematic review","volume":"7","author":"Patel","year":"2020","journal-title":"BMJ Open Respir Res"},{"key":"2026010701501363000_12.1.e002898.9","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1164\/rccm.202402-0368OC","article-title":"Association of Dose of Inhaled Corticosteroids and Frequency of Adverse Events","volume":"211","author":"Bloom","year":"2025","journal-title":"Am J Respir Crit Care Med"},{"key":"2026010701501363000_12.1.e002898.10","unstructured":"Health & Social Care Information Centre . Prescription cost analysis England. 2012."},{"key":"2026010701501363000_12.1.e002898.11","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02106-2021","article-title":"The environmental impact of inhaled therapy: making informed treatment choices","volume":"60","author":"Woodcock","year":"2022","journal-title":"Eur Respir J"},{"key":"2026010701501363000_12.1.e002898.12","doi-asserted-by":"publisher","DOI":"10.1080\/02770903.2019.1663429"},{"key":"2026010701501363000_12.1.e002898.13","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"2026010701501363000_12.1.e002898.14","doi-asserted-by":"crossref","unstructured":"Willig C , Rogers WS . The sage handbook of qualitative research in psychology . 1 Oliver\u2019s Yard, 55 City Road London EC1Y 1SP: SAGE Publications Ltd, 2017. Available: https:\/\/sk.sagepub.com\/reference\/the-sage-handbook-of-qualitative-research-in-psychology","DOI":"10.4135\/9781526405555"},{"key":"2026010701501363000_12.1.e002898.15","unstructured":"Primary Care Respiratory Society . Inhaler switching: making safe and clinically appropriate changes for patients with respiratory disease. 2023."},{"key":"2026010701501363000_12.1.e002898.16","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1093\/ijpp\/riac021.002","article-title":"Exploring elderly patients\u2019 perspectives on deprescribing: a qualitative study interim analysis","volume":"30","author":"Channa","year":"2022","journal-title":"Int J Pharm Pract"},{"key":"2026010701501363000_12.1.e002898.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-081305","article-title":"Determinants of implementing deprescribing for older adults in English care homes: a qualitative interview study","volume":"13","author":"Warmoth","year":"2023","journal-title":"BMJ Open"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2024-002898","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:50:33Z","timestamp":1767779433000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2024-002898"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,2,3]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bmjresp-2024-002898"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2024-002898","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}