Abstract
The cornerstone of asthma management is the stepwise approach recommended by both national and international guidelines. In this study, we aim to investigate physicians' attitudes and approaches towards step-down treatment in asthma management in Turkey. In this cross-sectional study, questionnaire-based data were gathered from pulmonologists, immunology and allergy specialists and immunology and allergy fellows in November-December 2024. Of the 225 physicians, the median years of service in their speciality was 5 (min1-max51) years. Nearly 35% of survey participants rarely step down asthma medication (12.9% and 52.4% of participants always and frequently, respectively). The two most selected barriers were 'I am afraid the patient will get worse' (50.9%) and 'patients don't want to' (29.9%). Participants whose primary concern regarding step-down asthma treatment was fear of patient deterioration were found to use step-down approaches less frequently (66.7%, p < 0.001). Working in educational and research hospitals, the fear that the patient may worsen, and infrequent adherence to guideline updates were significantly associated with the rare implementation of step-down treatment in asthma management. Our study identified that the fear of potential disease worsening and infrequent adherence to updated guidelines were significantly associated with the limited implementation of step-down treatment in asthma management.