Posted: April 3rd, 2022

Stepwise approach for asthma treatment

Stepwise approach for asthma treatment
Asthma is one of the most common inflammatory diseases worldwide. 22 million people are living with asthma in the United States of America, six million are children. Asthma is a chronic disease that requires regular therapy to put it under control. It is categorized into two, intermittent and persistent asthma. Persistent asthma is further divided into mild, moderate and severe.
Patients with intermittent asthma depict asthma symptoms two days per week, those with mild persistent asthma more than two days but not every day, and those with moderate and severe persistent asthma show the symptoms every day. Severe asthma is more serious and the patient exhibits the symptoms throughout the day.
According to the stepwise approach, patients with intermittent asthma should be given a rescue inhaler which is also known as SABA pm. Those with mild persistent asthma should get a SABA pm and low dosage of ICS daily. Every asthmatic patient should receive adequate education about asthma.
In the stepwise approach of asthma treatment, medical intervention is given in steps depending on the type of asthma. Step one is mostly given to intermittent patients. It entails the provision of SABA pm. Step two encompasses the provision of a low dose of ICS and SABA pm. Step three involves a medium dose of ICS and LABA. Step four, a medium dose of ICS and LABA. Step five a high dose of ICS and LABA and finally step six a high dose of ICS, LABA, and oral corticosteroids.
If a patient requires care that is beyond step four, an asthma specialist should be involved. Clinicians should consider subcutaneous allergen immunotherapy in steps 2 to 4 for patients with allergic asthma. If the disease is well controlled, the clinician might reduce care by one step. If the patient is not getting better the clinician might consider increasing care by one or two steps.
The stepwise approach came into existence after a report published by the National Asthma Education and Prevention Program with guidelines on the diagnosis and management of asthma. The report was guided by the findings of the Expert Panel Report (EPR) two and three. An interim update of the EPL-2 was published in 2002.
The report highlights details about the management of asthma. Management of asthma targets reducing risks and impairment. Impairment includes chronic symptoms such as breathlessness, frequent use of the inhaler and inability to perform normal activities. Risks encompass lung failure and increased hospitalizations.
References
National, A. E., & Prevention, P. (2007). Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. The Journal of allergy and clinical immunology, 120(5 Suppl), S94.
Nievas, I. F. F., & Anand, K. J. (2013). Severe acute asthma exacerbation in children: a stepwise approach for escalating therapy in a pediatric intensive care unit. The journal of pediatric pharmacology and therapeutics, 18(2), 88-104.
Sheffer, A. L., Bousquet, J., Busee, W. W., Clark, T. J. H., Dahl, R., Evans, D. … & Hurd, S. S. (1992). International consensus report on diagnosis and management of asthma. Allergy, 47(suppl. 13), R1-R61.

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