Stepping down to the lowest effective dose

Stepping down to the lowest effective dose

BTS/SIGN, NICE and GINA guidelines recommend that patients should be on the lowest effective dose of ICS that controls their asthma.1 – 3

The FFLUX study compared the effectiveness of switching adult patients controlled on Seretide® Evohaler® 250µg to flutiform 250µg.4

FFLUX was a pragmatic, open-label, randomised, non-inferiority trial that assessed the effectiveness of switching and stepping down to flutiform, with asthma control assessed according to ACQ7.4

Patients either remained on Seretide® Evohaler® 250/25µg, or were changed to flutiform 250/10µg. For phase II of the trial, 116 patients controlled on flutiform 250/10µg either remained on flutiform 250/10µg, or were stepped down to flutiform 125/5µg.



Patients who stepped across from Seretide® Evohaler® 250/25 µg to flutiform 250/10 µg experienced:

  • Non-inferior asthma control*4

    • according to ACQ7 questionnaire
    • difference in mean scores (95% CI): -0.12 (-0.32,0.09)
  • Significantly higher odds of being more controlled4

    • according to GINA Criteria3
    • odds ratio (95% CI): 2.00 (1.14,3.52), P = 0.016


Controlled patients who stepped down to flutiform 125/5µg:

  • Continued to benefit from good asthma control*4

    • difference in mean ACQ7 scores (95% CI): 0.01 (-0.20,0.22)

*The non-inferiority limit on the ACQ7 (7 item asthma control questionnaire) was set at 0.3


Read the Usmani OS et al, 2017 paper in full here



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  1. SIGN 153. British guideline on the management of asthma [Accessed February 2018].
  2. NICE NG80. Asthma: diagnosis, monitoring and chronic asthma management, November 2017. [Accessed February 2018].
  3. Global Initiative for Asthma (GINA) 2017 Pocket Guide for Asthma Prevention. [Accessed February 2018].
  4. Usmani OS, Kemppinen A, Gardener E, et al. Randomized pragmatic trial of changing to and stepping down fluticasone/formoterol in asthma. J Allergy Clin Immunol Pract. 2017 Sep - Oct;5(5):1378-1387.