Asthma and Stepwise management

Asthma and Stepwise management

Management of asthma

Asthma is a chronic condition characterized by the persistent narrowing of the airways due to inflammation which causes swelling and tightening of the airway muscles.  The disease is characterized by wheezing, coughing, shortness of breath and or tightness of the chest. Despite the fact that it cannot be cured, the implementation of appropriate management helps in the administration of the disease and improvement of the quality of life of patients. Asthma has a lower probability of deaths unlike other chronic obstructive pulmonary diseases but can kill very fast with lack of the appropriate drugs or the failure to use the important drugs for the condition (Al-Alawi, Hassan,& Chotirmall, 2014).

The management of asthma entails the use of short-term drugs to alleviate the symptoms while long-term medications are used to control the inflammation, prevent symptoms and also worsening of the condition. Avoiding the triggers which irritate and inflame the airway is also a strategy for the management of the condition (Arcangelo et al, 2017). Short-term medications for the quick relief of asthma symptoms include short-acting beta-agonists and corticosteroids. The short-acting beta-agonists are bronchodilators administered through inhalation and comprise of drugs such as albuterol, levalbuteral and pirbuterol. Prednisone and methyl predinisolone are cortocoseroids that can be used for acute asthma flare-ups or when there are severe symptoms but have serious side effects with long-term use (Ban et al 2015).

The long-term drugs for asthma management include inhaled cortocsteroids, long-acting beta agonists, and leukotriene modifiers. Cortocistreoids are anti-inflammatory drugs which relieve inflammation and open up the airway in asthma patients (Arcangelo et al, 2017). The mostly used corticosteroids include fluticasone, budesonide, ciclesonide, and beclomethasone among other drugs which are mainly inhaled drugs. The inhaled corticosteroids are combined with a long-acting beta agonist which helps in the dilatation of the airway allowing air entry. The long-acting beta agonists cannot be used singly and the some of the combinations include fluticasone and salmeterol, budesonide and formoterol and mometasone and formoterol. Leukotrine receptor antagonists such as are also used in the management of asthma. Other drugs such as theophyllines can also be administered to enhance bronchodilation and ease breathing (Chung et al 2013).

Stepwise Management of Asthma

The stepwise approach to the management of asthma is a strategy in which the dosages and the number of drugs used are adjusted accordingly to meet the therapeutic needs of the patient. The frequency of administration of medicines can also be changed with the aim of achieving and maintaining an optimal control of the illness. The drugs, doses, and frequencies are either increased or decreased as appropriate with the primary goal of meeting adequate control of the disease. The healthcare provider decides on whether to step down or to step up with the different drugs in the current therapy of the client (Kew et al 2015).

The client presentation guides the whole decision-making on where to step down or step up. A step up is applied in instances when there are poor control and many exacerbations of the disease to regain monitoring of the disease. A patient will be left if he or she has had prolonged periods with a reduction in symptoms and few exacerbations require a step-down.The stepwise management of asthma is vital to help asthma patients experience a high quality of life with the least number of drugs to control the asthma symptoms (Khalid, 2015).

Importance of the Stepwise Management

The primary goal of asthma management is to promote a high quality of life through an efficient management of the disease. A state of asthma control is achieved when the goals of therapy have been made. The achievement is characterized by the maintenance of a healthy lung function, a reduction in symptoms and also the presence of very few or absent exacerbations of asthma. The stepwise approach defines the targeted interventions which can work for each category of patients and ensures that the most viable options are considered. As a result, enhanced symptom control and prevention of exacerbations is achieved through the stepwise management (Postma, & Rabe, 2015).

The stepwise approach to the management of asthma offers a guideline to clinicians by highlighting the changes which can be made in therapeutic regimen. The adjustments are based on accurate clinical results of an individual patient which provide proven outcomes in favor of the patient. The healthcare providers can easily access the recommendations contained in the stepwise management guideline and use the information in managing a particular condition. The stepwise approach guarantees optimal results in achieving disease control for asthmatic patients. Clinicians not only gain guidance on the pharmacological management of asthma but also acquire data on the appropriate lifestyle modifications for the patient. The success of the stepwise approach lies in the cooperation between the patient and their physicians (Reddel et al 2015).


Asthma is a debilitating condition for patients who have not managed the disease appropriately. Asthmatic patients can, however, lead a very high quality of life given the correct control of symptoms and prevention of exacerbations. Different drugs are used in the management of asthma to elicit a variety of effects on the respiratory system which enhances the opening of the airway. The stepwise management of asthma offers a guideline on the management of asthmatic patients in different categories and entails increasing or reducing the doses appropriately for an individual patient depending on his or her clinical status.


Al-Alawi, M., Hassan, T., & Chotirmall, S. H. (2014). Advances in the diagnosis and management of asthma in older adults. The American journal of medicine, 127(5), 370-378.

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).     Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Ban, G. Y., Ye, Y. M., hwan Lee, Y., Lee, S. H., Kim, J. E., Nam, Y. H., … & Park, H. S. (2015). The Predictors for Asthma Control By Stepwise Treatment in Elderly Asthma Patients. Journal of Allergy and Clinical Immunology, 135(2), AB175.

Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., …& Boulet, L. P. (2013). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal, erj02020-2013.

Kew, K. M., Allison, D. E., Evans, D., & Boyter, A. C. (2015). Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus addition of long-acting beta2-agonists (LABA) for adults with asthma (Protocol). Cochrane Database of Systematic Reviews, 2015(Issue).

Khalid, A. N. (2015, September). Stepwise management of asthma. In International forum of allergy & rhinology (Vol. 5, No. S1).

Postma, D. S., & Rabe, K. F. (2015). The asthma–COPD overlap syndrome. New England Journal of Medicine, 373(13), 1241-1249.

Reddel, H. K., Bateman, E. D., Becker, A., Boulet, L. P., Cruz, A. A., Drazen, J. M., … & Lemanske, R. F. (2015). A summary of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal, 46(3), 622-639.


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