Studies have shown that doctors are 'unwilling' to bring down a child's high asthma medication to a lower dosage even after the condition has stabilised considerably.
In the study involving 310 pediatricians, 40 percent said they would not step down high-dose treatment even if a child's symptoms were well controlled and infrequent.
"Asthma medications can have serious, albeit infrequent, side effects, and while under-treatment is undeniably a big problem, not stepping down treatment when a child is doing well may be too," said lead investigator Sande Okelo,, an asthma specialist at Hopkins Children's.
"If a child is doing well and her symptoms are well under control, why not take that chance and see if a smaller dose would do the trick?" said investigator Gregory Diette, M.H.S., a lung specialist at Hopkins.
Beyond side effects, a failure by pediatricians to taper off drugs may also lead parents to do so on their own by skipping doses or decreasing them, said Okelo
"Past research shows that when parents are concerned about side effects and their child is doing well, they may take action without a doctor's approval," he added.
For the study, the pediatricians were asked to devise treatment plans using different patient scenarios, describing various elements, including whether a child had been hospitalized recently, how bothersome and frequent a child's symptoms were, whether symptoms had recently intensified or lessened and whether the child had wheezing on a physical exam.
While current treatment guidelines focus on symptom frequency, nearly all pediatricians reported using multiple factors in their decision-making, including quality of life and how bothered parents were by their child's symptoms.
Okelo said that pediatricians might greatly benefit from a step-by-step, "frontlines" tool that tells them how to specifically apply treatment guidelines and how to use different dimensions of the disease in their day-to-day practice.
Researchers suggests that as asthma is an unstable disease and can change often and unpredictably, it is essential that children with asthma get regular follow-up exams every three to six months even in the absence of symptoms.
The study appears in the July issue of Pediatrics.