Asthma and Stepwise Management

Asthma and Stepwise Management

Asthma is a chronic inflammatory respiratory disease of the airways characterized by airway obstruction, inflammation and hyperresponsiveness (Arcangelo and Peterson, 2013). The principal objective to treating asthma is to control the disease. Asthma control focuses on preventing problematic symptoms such as shortness of breath, wheezing, extreme coughing and/or frequent respiratory infections. In order to treat and control asthma, the advance practice nurses must be able to recognize and distinguish life-threatening symptoms and understand the stepwise management approach for treatment. There are two treatment choices that are utilized to treat asthma, long-term control and quick relief treatment. The purpose of this paper is to describe the long-term control and quick relief treatment and explain the stepwise approach to asthma treatment and management. Finally, the paper will also explain how stepwise management assist health care providers and patients in gaining and maintaining control of the disease. Asthma and Stepwise Management

Long-Term Control and Quick Relief Treatment

Long-Term Control

The goal of long-term control asthma pharmacotherapy is to prevent symptom flair ups and control asthma. According to Arcangelo and Peterson (2013), long-term control medications must be taken every day to achieve and maintain control in persistent cases. Long-term asthma medication is the most effective medication when preventing asthma attacks and controlling chronic symptoms. According to (2012), long-term medication includes inhaled corticosteroids, long-acting beta-agonists (LABAs), leukotriene modifiers, theophylline, and combination inhalers containing both LABAs and corticosteroids. One of the most important and effective long-term control medication is inhaled corticosteroid. This long-term medication is considered to be the most effective anti-inflammatory medication because it prevents the passage and stimulation of inflammatory cells. In return it prevents airway hyperresponsiveness, improves symptoms, and the function of the respiratory system. According to Arcangelo and Peterson (2013), the impact of inhaled corticosteroids includes oral fungus known as “thrush”, coughing, hoarseness, osteoporosis and easy bruising. In children one of the most crucial side effect is delayed or suppressed growth. It is important for advance practice nurses and physicians to monitor the effects of the medication and educate patients on the possible side effects. Asthma and Stepwise Management

Quick-Relief Treatment

Quick relief medications also known as “rescue medications” are used to control flair ups such as wheezing, shortness of breath, and extreme or severe coughing during an asthma attach. These medications are known as bronchodilators because they relax the airway muscles by eliminating the symptom. It is crucial that the asthmatic patient knows and understands the importance of keeping a rescue inhaler with them at all times. These medications have a faster onset to improve breathing and treat attacks versus the long-term control medications. These medications are Metaproterenol, Pirbuterol, Bitolterol, Terbutaline, Levalbterol, and Albuterol (, 2012). The advance practice nurse or physicians must establish an asthma action plan in regards to when the drug must be used and the amount to use during an attack with the patient (Bousquet, 2000). Although these medications eliminate symptoms during an attack, it is important to know the impact of the medication could cause tremors, headaches, anxiety, restlessness, and fast and uneven heartbeats in both adults and children (Arcangelo & Peterson, 2013). Asthma and Stepwise Management


Stepwise Approach to Treatment and Management

When asthma is diagnoses and the severity of disease is assessed, the advance practice nurse or physician will then utilize the stepwise approach to decide which step of therapy should be considered to coincide the proper level of asthma severity. The Expert Panel Report 3 from the National Asthma Education and Prevention Program (NAEPP EPR-3) (2007) recommends a stepwise approach to the implementation and adjustment of pharmacotherapy in asthma management. The purpose of the stepwise approach is to initiate a more intensive therapy to attain rapid control, and then step down to the least possible therapy. There are six steps outlined in the stepwise approach. Step one involves using a short acting beta-agonist to treat intermittent asthma. Steps two through six includes treating individuals with persistent asthma utilizing daily medication. According to the National Asthma Education and Prevention Program (NAEPP EPR-3) (2007), the following doses are recommended for each step; step two low-dose inhaled corticosteroids (ICS), step three a medium-dose ICS or low-dose LABA plus ICS, step four LABA and medium-dose ICS, step five a LABA and high-dose ICS, and step six an oral corticosteroid plus a LABA plus a high-dose ICS. Asthma and Stepwise Management

Stepwise Management Assist Health Care Providers and Patients

The stepwise approach is a tool that both the health care provider and patient can benefit from utilizing. When the approach is used the health care provider can utilize questionnaires to help determine if the level of control has been achieved (Osman et al., 1993). This provides an opportunity to determine if the current treatments are beneficial to the patient and the impact of the medication. The stepwise approach is critical in the management and prescribing of medication based on the stage of the disease and provides alternative medications. Comorbidities management, environmental control, and patient education accompany each stage of the stepwise approach, which is important in managing and treating asthma. Asthma and Stepwise Management


The main objective of asthma care is the accomplishment and maintenance of asthma control. This is achieved by decreasing the impairment and risk by utilizing pharmacotherapy and the stepwise approach. It is critical that health care providers and patients collaborate closely to identify the needs of the patients early. A thorough health history should be established to identify individual triggers for easier management and identifying the proper medications. Although there is no cure for asthma it can be controlled properly by the health care provider and patient. Asthma and Stepwise Management


Arcanglo, V.P., & Peterson, A.M., (Eds). (2013). Pharmacotherapuetics for advanced

practice: A practical approach (3rd). Ambler, PA: Lippincott Williams & Wilkins

Bousquet, J. (2000). Global initiative for asthma (GINA) and its objectives. Clinical and Experimental Allergy, 30(6; SUPP/1), 2-5. Asthma and Stepwise Management, (2012). Asthma. Retrieved from Asthma and Stepwise Management

Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services. Published August 28, 2007. Retrieved from

Osman, L. M., Russell, I. T., Friend, J. A., Legge, J. S., & Douglas, J. G. (1993). Predicting patient attitudes to asthma medication. Thorax, 48(8), 827-830 Asthma and Stepwise Management

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