How do you approach asthma patients who stop their maintenance inhaler due to symptom improvement soon after initiation of a biologic?

Prior to starting a biologic, I do explain that biologics are used as adjunctive therapy and not monotherapy for severe disease. Although there is a subset of patients who may be able to come of controller therapies after starting a biologic, the challenge is that insurance companies may see a decline in need for controller therapies as reason to stop covering the biologic. The first thing that I do, is assess the patient carefully for control on their current therapy (symptoms, rescue use, OCS ...

I acknowledge that I understand why they stopped the inhaler and I'm excited that they even felt like they could. I then add that they may still benefit from the bronchodilator component of an inhaler and that their airway inflammation was so high that it may still be a good idea to have a low dose ICS on board. If this doesn't work, I advise that sometimes insurance won't cover the biologic if they are not using a preventive inhaler. As irrational as that may be (insurance would rather pay for ...

In my practice experience, there are really two parts to the answer:

1. Presumably, the patient was started on the biologic because of inadequate control from maintenance inhaler (and other) therapy [I am purposely avoiding the conversation about starting a less severe asthma patient on a biologic to achieve a state of "asthma remission" - a very different discussion]. If the selected biologic is improving the patient's status (objective, subjective) enough that s/he can decrease/stop regular inha...