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Asthma and Stepwise Management


Asthma is one of the highly prevalent diseases with about 25.7 million people suffering from it in the United States (Tietze, 2017). It is a cause of almost half a million annual hospitalizations and kills nine people every day. Asthma is defined as “a heterogeneous chronic inflammatory medical condition of unknown etiology,” which means that the disease cannot be effectively prevented or successfully treated after it is diagnosed (Tietze, 2017, p. 488).

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Consequently, the options for managing asthma are to provide long-term control over the disease or achieve quick relief in case of an asthma attack. One of the most effective accepted approaches for asthma treatment and management is the stepwise approach. This paper aims to analyze long-term control and quick-relief treatment options for asthma patients, explain the essence of a stepwise approach to asthma treatment and management, and state the role of stepwise management for both patients and healthcare providers.

Treatment Options for Asthma Patients and their Impact

Treatment options for asthma patients depend on the type of disease or the trigger that stimulates the attack, asthma severity, and the age of a patient (Bernstein & Levy, 2014). Still, there are two basic treatment options common for all patients with asthma such as long-term control and quick-relief treatment. In case a patient experiences asthma symptoms more than twice a week, there is a need for daily medication to achieve a long-term effect.

Long-term controllers include anti-inflammatory medicines and bronchodilators (“Asthma treatment,” 2018). They are taken simultaneously to achieve the desired effect. For example, inhaled corticosteroids such as beclomethasone, budesonide, flunisolide, fluticasone, and mometasone are more effective for preventing asthma symptoms than relieving the attack. Despite certain side effects such as growth slowdown in children, corticosteroids have a proven efficiency to keep asthma under control (Divekar, Ameredes, & Calhoun, 2014).

Another popular medication for asthma is cromolyn sodium, which stops swelling in airways that develops as a reaction to contact with triggers. Montelukast, zafirlukast, and zileuton are used in the form of pills and reduce the negative effect of leukotrienes (“Asthma treatment,” 2018).

Bronchodilators are taken together with anti-inflammatory medicines and help to relax the muscles around the airways. Bronchodilators include inhaled long-acting beta2-agonists, which are applied for nighttime asthma or to manage the symptoms that appear during exercise. It is critical to combine them with inhaled corticosteroids. Combination inhalers are medications that include a bronchodilator and a corticosteroid (Divekar et al., 2014). Finally, Theophylline is a pill to manage severe asthma and is prescribed daily.

Quick-relief medication is expected to provide instant relief for symptoms that flare-up. Patients can use Inhaled short-acting beta2 agonists such as albuterol and levalbuterol, which have a loosening effect on tight muscles around the airway and release the airflow. Ipratropium is applied for quick airways relaxation and allows a patient to breathe. Finally, Corticosteroids are also used as quick-relief medication and can relieve swelling in the airways, which is frequent in case of severe asthma. However, they are prescribed for a short time due to adverse effects.

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Stepwise Approach to Asthma Treatment and Management

A stepwise approach to asthma treatment and management is one of the frequently used alternatives for dealing with this chronic condition. The recommended decisions according to this approach are based on the age of a patient and are divided into three groups, for children from birth to 4 years of age, for children aged 5-12, and for children older than 12 and adults (Tietze, 2017). Every scheme includes treatment and management options for six steps of the disease such as intermittent, mild persistent, two moderate persistent, and two severe persistent steps. The essence of this approach is that it allows altering medication use and treatment strategy, on the whole, depending on a patient’s condition, which changes under the impact of diverse factors such as environment, season, emotional condition, etc.

Role of Stepwise Management in Asthma Control

The stepwise approach is included in asthma guidelines and recommendations as the one to be used by physicians (Jonathan, 2014). This approach allows maintaining control of the disease and provision of the necessary treatment according to the patient’s needs. It is achieved due to an opportunity to select a step up or down in case patient monitoring shows that the condition improves or gets worse (American Academy of Asthma and Immunology, 2018). One of the important aspects that are included in the steps of this approach is the change of medication doses.


On the whole, asthma is a chronic condition that, despite active research in this field, cannot be prevented. Consequently, there is a need for approaches that allow managing and controlling this disease. One such approach is a stepwise one, which is grounded on changes in the dosing of long-term control and quick-relief medications. The choice of the medication option is made based on patient monitoring, which is an integral component of asthma management and treatment. Still, the most effective part of asthma treatment and management is the avoidance of triggers that stimulate the attacks.


American Academy of Asthma and Immunology. (2018). Follow the stepwise approach for asthma control. Web.

Asthma treatment. (2018). 

Bernstein, J. A., & Levy, M. L. (Eds). (2014). Clinical asthma: Theory and practice. Boca Raton, FL: Taylor & Francis.

Divekar, R., Ameredes, B. T., & Calhoun, W. J. (2014). Symptom-based controller therapy: A new paradigm for asthma patients. Current Allergy Asthma Reports, 13(5), 427-433. Web.

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Jonathan, P. (2014). Physician implementation of asthma management guidelines and recommendations: 2 case studies. The Journal of the American Osteopathic Association, 114, eS4-eS15. Web.

Tietze, K. J. (2017). Asthma. In V.P. Arcangelo et al. (Eds.). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.), (pp. 488-506). Ambler, PA: Wolters Kluwer.

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