Asthma and Stepwise Management


Asthma is a condition that affects people of any age and poses a serious threat to health and life. It is usually classified as a chronic disorder that blocks the airways, causes inflammation and/or hyperresponsiveness (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). The disease is rather widespread in the United States affecting eight to ten percent of the population. Most cases of asthma are atopy-related (Sayers, 2013). Children with a family history of asthma are at high risk of developing this condition. Among other conditions and illnesses that could contribute to the development of asthma are unmanaged rhinitis, gastroesophageal reflux disorder, stress, depression, and other possible health issues.

Asthma may be diagnosed if any or several criteria of the following are identified in a patient: occasionally obstructed inhalation, history of a cough, tightness in the chest, shortness of breath as a result of exercise, or exposure to allergens, at-night breathing problems. All of the above might become a reason for pulmonary function testing to measure forced expiratory volume and its relation to fluid volume capacity. Depending on the results and the consultation, doctors assign the type of asthma in accordance with its severity and frequency of symptoms.

Long-Term Control

In regard to long-term control of asthma, researchers suggest several major options of pharmacotherapy. As such, a randomized controlled trial conducted by Reiter et al. (2013) revealed that macrolides such as azithromycin are rather effective in relieving patients from the symptoms, increasing the quality of life, and reducing hyperreactivity of airways. Inhaled steroids such as beclomethasone, flunisolide, fluticasone propionate, and other names are also quite often used in the long-term management of asthma and are deemed increasingly helpful. They help reduce the incidence of symptoms and reverse the inflammation that is one of the main causes of symptoms (Arcangelo et al., 2017). The possible side effects are usually dose-dependent and are connected with errors in admission. Otherwise, they are relatively safe and non-damaging.

Among other medications used for long-term control of the disease, one can name mast cell stabilizers such as cromolyn sodium and nedocromil. Usually, they are prescribed to children who experience asthma symptoms during or after exercising. They are relatively safe to use and do not provoke issues with linear growth. Leukotriene modifiers such as zafirlukast or montelukast sodium could also be used for the same purposes. Possible side-effects might include a headache, typical for asthma medicines, fatigue, or fever.

Quick-Relief Treatment

Quick-relief treatment includes a range of bronchodilators and corticosteroids. As such, albuterol, terbutaline, metaproterenol, or levalbuterol could be used to manage the acute onset of symptoms and relieve bronchospasms (Conner & Buck, 2013). Notably, using several beta2 adrenergic agonists is not recommended. Possible side effects include a headache, nausea, fatigue, etc. The prolonged use of beta-adrenergic agonists is not recommended as it could adversely affect further treatment and the health of the patient.

Stepwise Approach to Asthma Treatment and Management

For each age group asthma treatment is slightly different but basically includes basic six steps that anticipate the preferred usage of medication depending on the severity and incidence of the symptoms as well as the assigned asthma type (Arcangelo et al., 2017). Step one describes the preferable and alternative management options for intermittent asthma in children of various age groups, and adults. In almost all cases and age groups, the first step begins with short action beta-agonists.

Steps from two to six address the usage of medication in patients with persistent asthma that require long-term management. The steps demonstrate the progression of dosage and combination of pharmacotherapeutic interventions. The beginning of the treatment is mostly marked by the use of a low dosage of inhaled corticosteroids. Severe cases feature the implementation of a combinatory pharmacotherapeutic treatment including corticosteroids in high doses and long action beta-agonists. Each step and the transition between them should be supported and guided by a medical professional who is capable of providing adequate patient education. A doctor should also pay attention to comorbidities and be able to adjust the treatment plan as needed.

Stepwise Management as a Tool for Maintaining Control of the Disease

From the health care provider’s point of view, a stepwise approach is an evidence-based tool for effective management and control of the disease. It summarizes the best practices and provides useful advice on how to proceed with treatment. Stepwise management assists clinicians in assessing the patient’s condition and acting accordingly. From the patient’s perspective, it may serve as a realistic outlook on the treatment flow and future disease management. Under no circumstances should it become a substitute for the professional medical decision, as each case is unique.


To conclude, stepwise asthma management is a useful tool aimed primarily at clinical professionals in order to support their decisions with evidence-based data. It offers a step-by-step outline of a typical process of management of the disease and medication solutions. Despite the fact that it is rather detailed, it cannot replace the expert opinion of a qualified medical professional and should be used only for consultation purposes.


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

Conner, J. B., & Buck, P. O. (2013). Improving asthma management: The case for mandatory inclusion of dose counters on all rescue bronchodilators. Journal of Asthma, 50(6), 658-663.

Reiter, J., Demirel, N., Mendy, A., Gasana, J., Vieira, E. R., Colin, A. A.,… Forno, E. (2013). Macrolides for the long‐term management of asthma–A meta‐analysis of randomized clinical trials. Allergy, 68(8), 1040-1049.

Sayers, I. (2013). A tailored approach to asthma management: Arg16 holds the key? Clinical Science, 124(8), 517-519.

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