Asthma and Stepwise Management

Asthma and Stepwise Management

Asthmaand Stepwise Management

Asthmaand Stepwise Management

Asthmais a respiratory disorder that affects both adults and children. Itinflames and narrows the patient’s airways making them to swell andproduce mucus. Asthma causes difficulties in breathing, triggerscoughing, chest tightness, recurring wheezing, and shortness ofbreath. Medics clearly states asthma as a chronic disease hence,medication should be carried throughout. According to Arcangeloand Peterson (2013),doctors should monitor the medication used to control asthma, andsometimes “stepping it down” or “stepping it up” to managethe symptoms. This approach to asthma management is known asstepwise. When a patient is first diagnosed with asthma, the doctorsmay prescribe high dosage of asthma controller medication until thecondition stabilises. Afterwards, the doctors just monitors thecondition by increasing “step up” or decreasing “step down”the medication dosage.

Long-termcontrol and quick relief treatment options for asthma patients, andtheirimpact on patients

Incase of asthma symptoms, asthma patient need quick-relief medicationto reduce the symptoms. Inhaled short-acting beta2-agonist andinhaled anticholinergicsare good examples of quick relief medicine. In case of a flare up,inhaled short-acting beta2-agonist relaxes the tight muscles thatsurround the airways. Correspondingly, the airways open letting theair to flow. On the other hand, inhaled anticholinergic blocksacetylcholine chemical that stimulate muscle contractions and slowsdown heartbeat. However, quick relief medicines do not reduceinflammation, but they only treat or prevent an asthma attack.Similar to other asthma medicines, inhaled short-actingbeta2-agonists and inhaled anticholinergicshave possible side effects. Studies show that they increase heartrate, hypokalemia, and shakiness (,2012).

Long-termmedication for asthma control includes anti-inflammatory drugs toreduce and prevent airways swelling. Inhaled corticosteroids areeffective and long-term inflammatory medications for asthma. Pooleand Peterson (2001) urges that inhaled corticosteroids are moreeffective and have fewer side effects compared to oralcorticosteroids. They prevent airways from swelling and reduce mucusin the lungs. They are effective in managing any level of persistentasthma, and improving pulmonary function. Nevertheless, oralcorticosteroids are also long-time medication of asthma.Corticosteroids controls and keeps inflammation down. According, possible side effects of using corticosteroids include oralthrush (candidiasis), voice change (hoarseness), and cough. Studiesshow that inhaled corticosteroids in children cause growth delay.Further, research shows that long-term use of corticosteroids causessystematic effects such as growth suppression, adrenal axissuppression, hypertension, cataracts, dermal thinning, and muscleweakness (, 2012).

Leukotrienemodifiers are also long-term medication for asthma, especially forchildren with mild persistent asthma. It improves asthma symptoms andpulmonary function. Research shows that usage of leukotriene causeselevation of liver enzymes (, 2012). In same rare cases,leukotriene usage has been associated with systematic eosinophiliaand vasculitis.

Inaddition, bronchodilators are long-acting asthma medication thatrelaxes muscles around the airways to open it. Long-acting beta2-agonist is an example of bronchodilators. It preventsexercise-induced bronchospasm and improves symptoms, especiallynighttime symptoms. Unlike short-acting beta2-agonists, they workslowly but last longer. Similar to short-acting beta2-agonists,long-acting beta2-agonist causes heart rate, hypokalemia, shakiness,and prolongation of QTC interval (,2012).

StepwiseApproach to Asthma Treatment and Management

Stepwiseapproach helps to control asthma condition in both risk andimpairment domains. It maintains asthma control with minimalmedication and risk for adverse effects. Stepwise approach determineswhen to increase or decrease medication and the frequency ofadministration. Doctors use stepwise approach to manage asthma inyouth above twelve years old and adults. The approach consists of sixsteps, and deciding the appropriate step depend whether the therapyis being adjusted or being initiated (NationalHeart Lung and Blood Institute, 2007).Medication is either stepped up or stepped down to regain control orreduce side effects risk respectively. Step 1 consists of SABA(short-acting beta-agonist), which is preferred because the patienthas intermittent symptoms only. Step 2 consists of preferred low doseof ICS (inhaled corticosteroids)and an alternative of cromolyn, Nedocromil, LTRA (LeukotrieneReceptor Antagonists),or Theophylline. Step 3 consists of preferred low-dose of ICS andLABA (Long-ActingBeta Adrenergic)or Medium-dose of ICS, and an alternative of low-dose ICS withTheophylline, LTRA, or Zileuton. Step 4 consists of preferredmedium-dose of ICS and LABA, and an alternative of medium-dose of ICSwith Theophylline, LTRA, or Zileuton. Step 5 consists of preferredhigh-dose of ICS and LABA while step 6 consists of preferredhigh-dose of ICS together with LABA and corticosteroid. In step 5 and6, omalizumab is also considered for patients with allergies.

Importanceof Stepwise Management to Health Care Providers and Patients

Kavuru(2008) states that stepwise approach as a significant approach tocontrol asthma condition. In addition, the approach works effectivelyto reduce both risk and impairment domains and progression. Likewise,stepwise approach helps asthmatic patients to track, scrutinize, andamend their medication depending on signs and symptoms hence,minimize exacerbations risks. Kavuru(2008) recommends asthmatic patients to write action plan of theirprogress. The plan should indicate the patient daily treatment plan,and the steps to take in case of a change. This guides the patient onhow to self-adjust the medication in case of a change. Stepwisemanagement plan helps the health care providers to give appropriatemedication as it plans and guides them through different levels basedon the patient signs and symptoms. Likewise, the plan guides the careproviders when to increase or decrease the intensity of treatment toachieve optimum asthma control.

Unfortunately,Asthma has no cure, but it is controllable. Luckily, there aremedicines that asthmatic use to control asthma condition. There aretwo types of medicines used to control asthma: quick relievers andpreventive medicines. Inhaled short-acting beta2-agonist and inhaledanticholinergicsare quick relief medicines while anti-inflammatorydrugs, Leukotriene modifiers, and bronchodilators are long-termmedicines for asthma. Doctors use stepwise approach to control asthmacondition. The approach helps them to prescribe the appropriatemedication based on the symptoms. When the condition is extreme, they“step up” and vice versa.


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Kavuru,M. S. (2008).&nbspDiagnosisand management of asthma.Caddo, OK: Professional Communications.

NationalHeart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3):Guidelines for the diagnosis and management of asthma. Retrieved from

Poole,A. V., &amp Peterson, A. M. (2001).&nbspPharmacotherapeuticsfor advanced practice: A practical approach.Philadelphia: Lippincott.