{
  "abstract": "Introduction and Objectives Biologic therapies have transformed severe asthma management, enabling improved control and reduced exacerbations. The Global Initiative for Asthma (GINA) guidelines 1 recommend considering stepwise reduction of background therapies in patients with sustained control on biologics but lacks tapering guidance for concurrent treatments. This novel and pragmatic pathway offers a strategy for de-escalation of multiple background therapies in well controlled biologic-treated patients within an NHS outpatient setting. The primary goal was to reduce treatment to the minimal effective dose of medication required to maintain clinical stability.Methods A structured deprescribing pathway (SDP) was developed (see figure 1) and implemented in severe asthma patients stable on biologic therapy for >12 months in a pharmacist-led clinic. Deprescribing data was collected for patients reviewed between March 2024 and March 2025. The SDP begins with stepwise withdrawal of add-on controller therapies including montelukast, theophylline, long-acting muscarinic antagonists (LAMA) inhalers and nasal corticosteroids followed by incremental dose reduction of high-dose inhaled corticosteroids and long-acting β2-agonists (HD-ICS/LABA) inhalers and cessation of short-acting β2-agonists (SABA) and nebulisers. Patients were safety-netted, and a telephone review conducted at 8–12 weeks after each de-escalation to assess symptom control prior to the next reduction.Results A total of 59 patients started the deprescribing pathway. So far, 100% (n= 11) theophylline, 98% (n= 45) montelukast, 82% (n= 49) LAMA inhalers, 85% (n= 13) steroid nasal sprays, 75% (n=4) of ICS nebulisers, 75% (n=4) SABA nebulisers were discontinued. 100% (n =8) SABAs were stopped as switched to Maintenance and Reliever Therapy (MART) and 91% (n=23) HD-ICS/LABAs were reduced to low or medium dose ICS/LABA.Abstract M32 Figure 1Summary of deprescribing pathwayConclusions This novel SDP appears to reduce polypharmacy associated with medication burden, side effects, and healthcare costs in patients well controlled on an asthma biologic. Next steps include expanding evaluation through quality metrics and patient reported outcomes.Reference Global Initiative for Asthma (GINA) (2024) Global strategy for asthma management and prevention. Available at: https://ginasthma.org/gina-reports/ (Accessed: 11 June 2025).",
  "authors": [
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "H Sakota"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "GW Nava"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "C Morgan"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "J Grenville"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "S Mulholland"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "N Leung"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "E Hunter"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "D Higbee"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "JW Dodd"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "R Shrimanker"
    }
  ],
  "title": "M32 A novel pathway for pharmacist-led stepwise de-escalation of background asthma therapy in patients stable on biologics. Experience from Bristol complex airways service",
  "uid": "f8f12da9-d77f-5fda-b621-64c146a93c76"
}