The Stepwise Management of Asthma

• The Stepwise Management of Asthma
• Introduction
• A stepwise approach to asthma management can involve both step-down or step-up therapies.
• Step-down therapy entails initiating a high-dose treatment and reducing it during successive visits if control has not been adequately accomplished (Falk, Hughes, & Rodgers, 2016). The reverse is true for the step-up approach.

Asthma affects both children and adults and is a major health concern globally. The prevention of symptoms by controlling airway hyperreactivity and inflammation is the principal goal of treatment.

• Long-term Control and Quick Relief Treatment
• Long-term control involves taking medication on a daily basis to accomplish and maintain the control of chronic asthma.
• Common medication used in achieving long-term control include Advair, QVAR, Flovent, Pulmicort, and Singulair (Bonewit-West, Hunt, & Applegate, 2015).
• Contrarily, quick relief medications afford fast relief for congested or tight airways and associated symptoms of wheezing, chest tightness, and coughing that attend asthma.
• Medications used for quick relief include Maxiar, Proventil HFA, ventolin HFA, Xopenex, albuterol, and ProAir HFA.

Long-term medications are broadly categorized as corticosteroids, immunomodulators, leukotriene modifiers, and long-acting beta agonists. Quick relief medicines, on the other hand, relieve the symptoms of asthma immediately they happen.

• Potential Impacts of Medication on Patients
• Medications for both long-term control and the quick relief of asthma can have side effects on patients.
• Inhaled corticosteroids prevent symptoms, but do not relieve an attack when it has begun (Gibson, 2019).
• Possible side effects of inhaled corticosteroids include oral candidiasis, sore throat and mouth, short-term dysphonia, reduced bone density (adults), cataract, glaucoma, spasms of the trachea (reflex coughs), and slightly reduced growth in children (Walsh, 2019).
• Beta antagonists (short- and long-acting) can cause increased pulse rate, anxiety, rash, dizziness, and headache.

Gargling and rinsing after using inhaled corticosteroids can prevent local adverse effects. The side effects of beta antagonists resolve quickly. However, rescue inhaler should not be overused, as doing so increases the risk of a severe attack.

• The Stepwise Approach – Patients
• The stepwise approach to the treatment and management of asthma can involve a step-down therapy or step-up therapy (Bernstein& Mansfield, 2019).
• Step-up therapy involves beginning with low-dose treatment that is increased gradually until optimal control is achieved.
• Step-won therapy, contrarily, involves starting with a higher dose that is reduced gradually as stability in the control of asthma is achieved.
• Step-down therapy seems to be more effective and beneficial in the treatment and management of asthma.