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● You de-escalate as your goal is to control asthma with the lowest sufficient of the 5 standard Therapy Steps. Controlled asthma is defined by daytime symptoms and reliever use ≤2x/week and by the absence of other asthma features.
● Attempt de-escalation  if asthma has been controlled for >3 months.
● De-escalating measures depend on the patient's current Therapy Step. Typical examples are the reduction of glucocorticosteroids or discontinuation of long-acting B2 agonists. Inhaled glucocorticoids should be initially halved and then phased out, but never upon continuing treatment with a long-acting B2 agonist.
● While de-escalating therapy, confirm asthma control every 4 weeks. Attempt further de-escalating steps at intervals of >3 months.
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