@entity1030 ( @entity1030 ) guidelines and strategies suggest escalating treatment, mainly depending on the severity of @entity1030 . However, some de-escalation of therapy in @entity1030 would be appropriate, although we still do not know when we should switch, step-up or step-down treatments in our @entity1 . Unfortunately, trials comparing different strategies of step-up and step-down treatment (e.g. treatment initiation with one single agent and then further step-up if symptoms are not controlled versus initial use of double or triple therapy, possibly with lower doses of the individual components, or the role of @entity898 in combination therapy for a step-down approach) are still lacking. In general, there is a large and often inappropriate use of the @entity4185 ( @entity4185 )/long-acting b2-agonist (LABA) combination. However, the withdrawal of the @entity4185 in @entity1030 @entity1 at low risk of exacerbation can be safe, provided that @entity1 are under regular treatment with long-acting bronchodilators. Maximising the treatment in @entity1 with a degree of clinical instability by including an @entity4185 in the therapeutic regimen is useful to control the disease, but may not be needed during periods of clinical stability. In @entity1 with severe but stable @entity1030 , the withdrawal of the @entity4185 from triple therapy [LABA + long-acting muscarinic antagonist (LAMA) + @entity4185 ] is possible, but not when the @entity1 has been hospitalised for an acute exacerbation of @entity1030 . We must still establish how long we should wait before withdrawing the @entity4185 . It is still unclear whether the same is true when only the LABA or the LAMA is withdrawn while continuing treatment with the other bronchodilator and the @entity4185 . In any case, we strongly believe that it is always better to avoid a therapeutic step-up progression when it is not needed rather than being forced subsequently into a step-down approach in which the outcome is always unpredictable.

Escalation and De-escalation of Therapy in XXXX : Myths, Realities and Perspectives.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity4185 :: ('MESH:D058545', 'Disease') :: ['ICS', 'inhaled corticosteroid'] @entity898 :: ('MESH:D000111', 'Chemical') :: ['N-acetylcysteine'] @entity1030 :: ('MESH:D029424', 'Disease') :: ['airflow obstruction', 'Chronic obstructive pulmonary disease', 'COPD']
@entity1030 :: (MESH:D029424,Disease) :: ['COPD']
