What do systematic reviews say?

ICS dose reduction vs no change

It is very uncertain whether ICS dose reduction changes exacerbation requiring OCS compared with no change (very low certainty).

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  OR 1.86 [0.16, 21.09]
  2 studies · 261 participants
  Very low
• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  OR 1.31 [0.82, 2.08]
  2 studies · 569 participants
  Low

ICS dose reduction vs no change

ICS dose reduction showed no clear difference in all‐cause SAEs compared with no change (low certainty).

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  OR 0.6 [0.11, 3.33]
  2 studies · 569 participants
  Low
• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  OR 1.24 [0.25, 6.25]
  2 studies · 742 participants
  Low

ICS dose reduction vs no change

The review found no eligible studies for this question.

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

ICS dose reduction vs no change

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 229 participants
  Low

ICS dose reduction vs no change

ICS dose reduction showed no clear difference in exacerbation requiring hospitalisation compared with no change (low certainty).

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  OR 4.06 [0.45, 36.86]
  2 studies · 569 participants
  Low

ICS dose reduction vs no change

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 14 participants
  Very low

ICS dose reduction vs no change

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 150 participants
  Low

ICS dose reduction vs no change

It is very uncertain whether ICS dose reduction changes steroid‐related AEs compared with no change (very low certainty).

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  OR 0.76 [0.16, 3.54]
  2 studies · 261 participants
  Very low

ICS dose reduction vs no change

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 554 participants
  Very low

ICS dose reduction vs no change

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 261 participants
  Low

ICS dose reduction vs no change

The review found no eligible studies for this question.

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

ICS dose reduction vs no change

• Stepping down the dose of inhaled corticosteroids for adults with asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 242 participants
  Low

Adherence education vs controls

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 280 participants
  Low

Electronic trackers or reminders (± feedback) vs controls

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 109 participants
  Low
• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 596 participants
  Low

Electronic trackers or reminders (± feedback) vs controls

Electronic trackers or reminders (± feedback) showed no clear difference in unscheduled healthcare visits to a healthcare provider (ED) WMD of compared with controls (moderate certainty).

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  OR 1.14 [0.88, 1.47]
  2 studies · 2918 participants
  Moderate

Electronic trackers or reminders (± feedback) vs controls

Electronic trackers or reminders (± feedback) showed no clear difference in absenteeism (people with at least 1 absence) compared with controls (low certainty).

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  OR 1.42 [0.82, 2.47]
  1 study · 220 participants
  Low

Electronic trackers or reminders (± feedback) vs controls

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 369 participants
  Moderate

Simplified vs usual regimens

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 1310 participants
  Moderate

Simplified vs usual regimens

Simplified showed no clear difference in exacerbations requiring OCS People with 1 or more compared with usual regimens (low certainty).

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  OR 2.33 [0.17, 32.58]
  1 study · 16 participants
  Low

Simplified vs usual regimens

• Interventions to improve adherence to inhaled steroids for asthma 2017 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 103 participants
  Moderate