Asthma’s Stepwise Management


The primary danger of asthma as a disease is the fact that it requires different interventions, based on the symptoms that an individual has. Additionally, the nature of the condition implies that one can have either an attack or an asthma-free day, which requires different approaches to management. Asthma affects many people in the US, and thus an advanced practice nurse must be aware of all aspects that can help patients. This paper aims to analyze approaches to treating asthma and examine stepwise management.

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Asthma Management Goals

Because the condition in question is chronic, cooperation between a healthcare provider and a patient is necessary to set appropriate goals and choose treatment options. The long-term control of the condition involves medications that help ease the symptoms and allow individuals to lead a normal life (Zahran, Bailey, Qin, & Johnson, 2017). Additionally, this method enables preventing possible asthma attacks and other severe outcomes by reducing potential risks. This can be achieved by using screening tools and monitoring the condition of an individual to identify whether the disease is well-controlled, partially managed, or uncontrolled.

Corticosteroids are commonly used by medical professionals to improve the patient’s condition in the long term. According to Arcangelo and Peterson (2013), “it takes approximately two weeks of continuous therapy for inhaled steroids to achieve maximum effectiveness” (p. 307). The authors provide an extensive explanation of possible medications that should be chosen by the severity of symptoms that a patient has.

For instance, when prescribing corticosteroids, a medical professional should use the lowest dose that will be effective in a particular case (Siddaway, 2018). Therefore, it is necessary to ensure that patients understand the importance of adherence to recommendations from providers as asthma requires constant attention and management. This would allow a healthcare provider to monitor the condition of individuals and readjust the treatment plan.

The quick relief that can be used in emergency cases when a patient displays severe symptoms such as difficulty when breathing, or when an asthma attack is in place. According to Jonathan (2014), short-acting bronchodilators should be applied to ensure that the muscles of the airways are relaxed. The medication allows mitigating the acute condition within several minutes after it was inhaled. However, its use should be controlled by a healthcare provider to ensure that a person is not over-treating himself or herself.


The stepwise approach involves adjusting the medication by the symptoms that a patient has to manage the disease adequately. The method was developed to ensure that individuals are not over-treated with unnecessary medication in cases when their symptoms are less severe. The approach is viable because of asthma’s nature and the possibility to control the condition over extended periods.

Stepwise management assists both healthcare providers and patients by mitigating possible risks and side effects connected to pharmacological treatments. This requires cooperation between an individual and his or her medical provider. Therefore, the primary objective of the stepwise strategy is to monitor the patient’s condition and either lower or increase the amount of medication he or she is taking.

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Similarly to the long-term objectives, stepwise aims to provide an individual with the possibility to live a symptom-free life. Siddaway (2018) states that “asthma management guidelines recommend an individualized approach, in which pharmacological treatment is reduced when appropriate to ensure the lowest effective dose of inhaled corticosteroid is being used” (p. 18). In this way, patients do not have to visit the emergency department because they are receiving medication that is sufficient to control their symptoms.

The one downside of stepwise that Siddaway (2018) mentions a fear that medical practitioners have in regards to lowering the amount of medication that a patient receives. Additionally, a patient must understand that only a medical professional can make decisions regarding the appropriate dose; thus individuals should not alter his or her pharmacological treatment without consulting a professional.

While lower the amount of medication that a patient takes is vital to reduce risks, it is important to monitor his or her condition. Jonathan (2014) states that “the stepwise approach is meant to assist, not replace, the clinical decision making” (p. 14). Therefore, a nurse practitioner should pay particular attention to asthma patients and adjust the doses to the symptoms, by either stepping up the necessary pharmacological intervention or stepping down.


Overall, asthma is a severe condition that requires continuous monitoring from both a patient and his or her healthcare provider. The long-term goal of treatment is to ensure that a patient can live a normal life without any difficulties with breathing. In the short term, a medical professional should ensure that medication is prescribed that mitigates the severity of symptoms. Stepwise is recommended as an approach to managing the condition because it requires adjustment of pharmacological interventions in regards to the current state of an individual; thus it mitigates possible risk associated with overtreatment.


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

Jonathan, D. P. (2014). Physician implementation of asthma management guidelines and recommendations: 2 case studies. Journal of the American Osteopathic Association, 14(114), 14-15. Web.

Siddaway, D. (2018). Stepping down asthma treatment: perceptions of primary care staff. Nursing Times, 114(4), 18-21.

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Zahran, H. S., Bailey, C. M., Qin, X., Johnson, C. (2017). Long-term control medication use and asthma control status among children and adults with asthma. The Journal of Asthma, 54(10), 1065-1072. Web.

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