Asthma and Stepwise Management


Asthma and Stepwise Management


            Asthma results from airways’ inflammation. It is a long-term respiratory disease that is accompanied by symptoms such as coughing, breathlessness, and wheezing. These symptoms’ severity varies depending on individuals but the condition can be managed effectively in most cases. So as to be able to treat the condition immediately, it is imperative for professionals to be able to differentiate and identify between critical, life-threatening and minor symptoms (Arcangelo & Peterson, 2013). Usually, symptoms and triggers are triggered by a particular factor, which calls for the need to help patients identify their triggers. As a result, management strategies are made based on the individual cases. Personal patient factors establish the appropriate approaches for the treatment and management of disease. This paper aims at discussing the stepwise approach in the management of asthma.

Long-term control

            According to Arcangelo and Peterson (2013), long-term control medications have to be taken every day in order to achieve and maintain control in persistent cases. Currently, corticosteroids are considered the most potent and efficient anti-flammatory medications. Corticosteroids prevent the migration and activation of inflammatory cells. Moreover, they reduce airway hyper- responsiveness. Omalizumab is recommendable for patients aged > 12 years and those with allergies and severe persistent conditions (Leuppi et al., 2001). Salmeterol and formoterol are long-acting beta-agonists that control and prevent symptoms in moderate and severe persistent cases. Inhaled corticosteroids help in managing persistent cases regardless of the level of severity, which improves the symptoms and functions of the pulmonary system.

Quick relief treatment options

            These ‘rescue drugs’ are extremely effective in controlling symptoms. An individual can take them when wheezing, having trouble breathing, coughing, or during an attack. Owing to the fact that they are useful in relaxing airway muscles, they are also referred to as ‘bronchodilators.’

The medical professional and patient can work out a plan regarding the time and amount of drugs that should be taken (Bousquet, 2000).  A patient should always carry adequate amounts of the drugs so as to ensure that they have sufficient stocks while on a journey. Short-acting beta-agonists are useful for treating attacks, for instance before an exercise, as they help in relaxing the airway muscles. These include Metaproterenol, Pirbuterol, Bitolterol, Terbutaline, Levalbterol, and Albuterol. Oral steroids are taken if an individual has ongoing attacks.

Implications of the drugs on patients

            In adults and children, short-acting Beta-agonists cause tremor, headache, anxiety, restlessness, and fast and uneven heartbeats (Arcangelo & Peterson, 2013). Inhaled corticosteroids’ side effects include adrenal suppression, oral thrush, coughing, hoarseness, osteoporosis, and easy bruising. Following consumption by children, inhaled corticosteroids lead to delayed or suppressed growth. Oral corticosteroids lead to diabetes, cataracts, hypertension, weakness, muscle weakness, impaired immune function, mood changes, weight gain, and peptic cancer (Warner et al., 1989).

The stepwise approach to asthma treatment and management

            With the stepwise approach, the aim is escalating the number of medications, administration frequency, and dose and minimizing them when necessary. Initially, treatment is administered based on the condition’s severity but later, it is based on current asthma control. There is a need to consider omalizumab and immunotherapy. Multiple variables should be assessed simultaneously when checking on recent and current impairment. Short-term and more universal assessments ought to be considered (Bateman et al., 2008).

            During the first step, SABA PRN is preferred for treating intermittent asthma. Steps 2- 6 involves treating persistent asthma using daily medication. The following doses are preferred for these steps; step 2- low-dose ICS, 3- medium-dose ICS or low-dose LABA + ICS, 4- LABA and medium-dose ICS, 5- LABA and high-dose ICS, 6- oral corticosteroid+ LABA+ high-dose ICS. A specialist should be consulted at step 4 while an individual should consider consultation during the 3rd stage. Every step should be accompanied by comorbidities management, environmental control, and patient education.

How the stepwise management helps patients and healthcare providers in maintaining and gaining control of asthma

            Both providers and patients benefit from the stepwise approach. The validated questionnaires help patients and clinicians in determining the level of control a patient has achieved on a short-term basis (Osman et al., 1993). Therefore, current treatments are made beneficial to patients and there is a focus on minimal risks. The disease’s frequency and severity is easy to trace among the clinicians and patients. The stepwise management also helps in that medications are prescribed depending on the stage of the disease and there are alternative medications if the main ones are not available. in addition, every stage is accompanied by comorbidities management, environmental control, and patient education, which go a long way in managing the disease.


Both the stepwise approach and drugs can manage asthma effectively. However, it is vital that the providers and patients have a close collaboration so as to identify patient needs early enough. Individual triggers should be identified for easier management of the management. Long-term control involves the use of Corticosteroids, Omalizumab, Salmeterol and formoterol, Inhaled corticosteroids. The stepwise management of the disease has 6 vital steps and through them, providers and patients are able to manage the disease easily.





Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

Bateman, E. D., Hurd, S. S., Barnes, P. J., Bousquet, J., Drazen, J. M., FitzGerald, M., & Zar, H. J.  (2008). Global strategy for asthma management and prevention: GINA executive summary. European Respiratory Journal, 31(1), 143-178.

Bousquet, J. (2000). Global initiative for asthma (GINA) and its objectives. Clinical and Experimental Allergy, 30(6; SUPP/1), 2-5.

Leuppi, J. D., Salome, C. M., Jenkins, C. R., Anderson, S. D., Xuan, W. E. I., Marks, G. B., & Woolcock, A. J. (2001). Predictive markers of asthma exacerbation during stepwise dose reduction of inhaled corticosteroids. American journal of respiratory and critical care medicine, 163(2), 406-412.

Osman, L. M., Russell, I. T., Friend, J. A., Legge, J. S., & Douglas, J. G. (1993). Predicting patient attitudes to asthma medication. Thorax, 48(8), 827-830.

Warner, J. O., Götz, M., Landau, L. I., Levison, H., Milner, A. D., Pedersen, S., & Silverman, M. (1989). Management of asthma: a consensus statement. Archives of disease in childhood, 64(7), 1065-1079.


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