Treatment Alternatives and Stepwise Management

Both the quick and long term treatment options for asthma are administered on a day to day terms with purposes of maintaining as well as achieving control of this persistent ailment. Some of the long-term medication for the disorder includes the corticosteroids. The drugs block the late-phase reaction to an allergen. The medicine also reduces the hyper-responsiveness of the airway as well inhibiting the inflammatory cell activation and migration. The corticosteroids are the most effective and potent anti-inflammatory drugs. The inhaled corticosteroids are used in controlling asthma on a long term period. However, regardless of their effectiveness, the inhaled form of medication is associated with side effects, especially at lower doses. For example, thrush, commonly known as a yeast ailment in the mouth, as well as hoarseness may be experienced by the patient. However, the side effect can be avoided by embrace the practice of mouth gargling after using the inhaler. Additionally, the spacer device accompanied with the metered dose inhalers can also be used in preventing the side effects. Additional, the thrush side effect can be cured when the patient is prescribed with the antifungal lozenge. Asthma is best treated by adopting the stepwise approach management.

Stages of Stepwise Management

Step one of the approach applies to persons of all ages. The medication offered in this step is the short acting beta agonist, for example, the albuterol prn (Holt, 2009). If this drug does not improve the patient’s ill status for more than two days, the patient should put into consideration the option of visiting another other treatment options. The second step also applies to persons of all ages. The preferred medication at this level is the low-dose inhaled steroid. For individuals aged zero to four, they are advised to consider referral option, particularly if the diagnosis is in doubt. Step three applies for a person aged 12 years and above (Holt, 2009). The preferred prescription is the low-dose inhaled steroid together with the long-acting beta agonist. For individuals aged 0-4 years, they should be administered with the medium-dose inhaled steroid. Step four is also adopted for individuals aged 12 years and above. The medium-dose inhaled steroids as well as the long-acting beta agonist are most preferred in this case (Holt, 2009).

Step five of the step approach treatment is also adopted for patient aged 12 years and above. At this level, the patient should not be prescribed with the medium dose inhaled steroids; rather, they should be prescribed with the long-acting beta agonist (Thomas, Lemanske & Jackson, 2011). Especially, the omalizumab should be considered if the disorder is accompanied with other allergies. Omalizumab should be taken into account in case allergies are present. For patients aged five to eleven, similar prescriptions as those in the previous steps are adopted. Relevance of Stepwise Management Although there are other approaches used in the management and control of the Asthma, just like other ailments, the stepwise approach assists both the caregiver and the patient in making decisions related to drug therapy plans (Arcangelo & Peterson, 2013). The decision made are based on some factors, for example, the condition of the patient as well as whether the patient as allergies or not.


In conclusion, , the patient should be advised of methods that quick relief and control options, impact asthma drugs have on admitted patients, the stepwise method on controlling and treating patients, and how this method helps the patient as well as the caregiver in obtaining and maintaining control of the ailment.


Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 25, “Asthma” (pp. 346–364)

Holt, T. (2009). Stepwise approach to asthma management. RT: The Journal For Respiratory Care Practitioners, 22(5), 12-17.

Thomas, A., Lemanske, J. F., & Jackson, D. J. (2011). Reviews and feature article: Approaches to stepping up and stepping down care in asthmatic patients. The Journal Of Allergy And Clinical Immunology, 128915-924. doi:10.1016/j.jaci.2011.07.014