Asthma and Stepwise Management

Application: Asthma and Stepwise Management
Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses
often provide treatment to patients with these disorders. Sometimes patients require
immediate treatment making it essential that you recognize and distinguish minor asthma
symptoms from serious, life-threatening symptoms. Since symptoms and attacks are often
induced by a trigger, advanced practice nurses must also help patients identify their
triggers and recommend appropriate management options. Like many other disorders,
there are various approaches to treating and managing care for asthmatic patients
depending on individual patient factors. One method that supports the clinical decision-
making of drug therapy plans for asthmatic patients is the stepwise approach, which you
explore in this Assignment.
To prepare:
Consider drugs used to treat asthmatic patients including long-term control and quick
relief treatment options for patients. Think about the impact these drugs might have on
patients including adults and children.. Reflect on using the stepwise approach to asthma
treatment and management.
Consider how stepwise management assists health care providers and patients in gaining
and maintaining control of the disease.
To complete:
Write a 3 to 4 – page paper that addresses the following:
Describe long-term control and quick relief treatment options for asthma patients, as well
as the impact these drugs might have on patients.
Explain the stepwise approach to asthma treatment and management.
Explain how stepwise management assists health care providers and patients in gaining
and maintaining control of the disease. Make sure you have introduction and conclusion

Asthma and Stepwise Management


Following the inflammation of the airways, there could be a resultant long-term
respiratory condition that leads to breathlessness, wheezing, and coughing; asthma. How severe
these symptoms are differs between people. In a majority of the people, there has been effective
management of the disease most of the times. Immediate treatment of the condition calls for the
ability to identify and differentiate between minor and grave, life-threatening asthma symptoms.
Normally, attacks and symptoms are as a result of particular trigger. Therefore, advanced
practice nurses should assist patients in identifying their triggers (Warner et al., 1989). This
allows recommendation of the most appropriate management strategies. Individual patient

factors determine the proper approaches for managing and treating asthma including drug
therapy plans and the stepwise approach. This paper aims at discussing the long-term control and
quick relief options, how the drugs impact on patients, the stepwise approach, and how the
stepwise approach helps in gaining and maintaining control of the disease.
Long-term control
Long-term control medications are taken on a daily basis so as to maintain and achieve
control in cases of persistent asthma. Corticosteroids are presently the most effective and potent
anti-inflammatory medication. The prevent activation and migration of inflammatory cells and
minimize airway hyper responsiveness. Immunomodulators (Omalizumab) is administered to
patients aged more than 12 years who have severe persistent asthma and allergies. Leukotriene
modifiers include 5-lipoxygenase inhibitor (montelukast and zafirlukast) and leukotriene
receptor antagonists. Long-acting beta-agonists include formoterol and salmeterol, which prevent
and control symptoms in severe or moderate persistent asthma (Bernstein, Campo & Baur,
Inhaled corticosteroids mange persistent asthma irrespective of the severity level and this
improves pulmonary function and symptoms. If used, quick-relief medications may not be
Quick relief treatment options
Normally, the quick-relief drugs are also referred to as the ‘rescue drugs’ and they are
exceptionally efficient in controlling asthma symptoms. A person can take them when
experiencing an attack, experiencing trouble breathing, wheezing, and coughing (Sheffer &
Taggart, 1993). These drugs are also referred to as ‘bronchodilators’ as they assist in relaxing
the airway muscles. The patient and doctor can work out a plan regarding when the amount and

when to take the drugs. It is important for a patient to always plan ahead and carry enough
amounts so as to prevent the stock from running out when travelling.
Short-acting Beta-agonists
These drugs are very common for treating attacks. If taken prior to an exercise, they
prevent exercise-related symptoms. A person is able to breath in a better way during an attack
since the drugs relax the airway muscles. It is important for a patient to discuss with the doctor
so as to assess the need of changing the dose. Some of these drugs include Levalbterol,
Bitolterol, Terbutaline, Pirbuterol, Metaproterenol, and Albuterol.
Oral steroids
According to Bousquet (2000), oral steroids are prescribed in case a patient has an
ongoing attack. These drugs are taken by the mouth and include liquids, capsules, and pills.
Mostly, these drugs are taken for three to ten days. They include methylprednisolone,
prednisolone, and prednisone.
Impacts of drugs on patients
Short-acting Beta-agonists are associated with headache, restlessness, tremor, anxiety,
and irregular and fast heartbeats in both children and adults. Inhaled corticosteroids have side
effects such as oral thrush, hoarseness, cough, adrenal suppression, easy bruising and
osteoporosis. In children, inhaled corticosteroids result to growth suppression or delay. Oral
corticosteroids are used prior to beginning long-term therapy and for managing persistent and
poorly managed asthma. Oral corticosteroids are often associated with growth, diabetes,
hypertension, cataracts, impaired immune function, muscle weakness, increased appetite, mood
change, peptic cancer, and weight gain.
Stepwise approach for management and treatment of asthma

The management of asthma basically aims at controlling the disease in a safe and
efficient manner. Another goal is maintaining control with as minimum medications as possible,
which reduces vulnerability to adverse effects. The stepwise approach focuses on increasing the
administration frequency, number of medications, and dose whenever necessary and reducing
these if necessary. Initially, treatment correlates with the severity of the disease but afterwards,
treatment depends on present asthma control. Allergen immunotherapy and omalizumab should
be considered. There is a need to assess multiple variables simultaneously when assessing recent
as well as current impairment. More global and short-term assessments should be used.
How the approach assists patients and health care providers in gaining and maintaining
control of asthma
The step wise management of asthma has been proved to be particularly effective to both
patients and health care providers (Bateman et al., 2008). For instance, the validated asthma
questionnaires are vital in assisting clinicians and patients to determine the degree of control
experienced in a short term period. This ensures that the present treatment is beneficial to the
patient and minimal risks are being experienced. Moreover, the severity and frequency of the
disease can be traced easily among patients and clinicians.
From the foregoing discussion, it is evident that drugs and the stepwise approach can be
used to manage asthma effectively. There is a need for a close collaboration between patients and
clinicians so as to determine the need for changes.



Bateman, E. D., Hurd, S. S., Barnes, P. J., Bousquet, J., Drazen, J. M., FitzGerald, M., … & Zar,
H. J. (2008). Global strategy for asthma management and prevention: GINA executive
summary. European Respiratory Journal, 31(1), 143-178.
Bernstein, D. I., Campo, P., & Baur, X. (1999). Clinical assessment and management of
occupational asthma. Asthma in the Workplace. New York, NY: Marcel Dekker, 145-157.
Bousquet, J. (2000). Global initiative for asthma (GINA) and its objectives. Clinical and
Experimental Allergy, 30(6; SUPP/1), 2-5.
Sheffer, A. L., & Taggart, V. S. (1993). The National Asthma Education Program: expert panel
report guidelines for the diagnosis and management of asthma. Medical care, MS20-
Warner, J. O., Götz, M., Landau, L. I., Levison, H., Milner, A. D., Pedersen, S., & Silverman, M.
(1989). Management of asthma: a consensus statement. Archives of disease in childhood,
64(7), 1065-1079.