Asthma and Its Stepwise Management

Asthma treatment

As practice shows, patients with asthma can rely on several options in their treatment.

One option is using medications for long-term control of symptoms to prevent asthma attacks (Zahran et al., 2017). The level of asthma control depends on the frequency and intensity of symptoms (Zahran et al., 2017).

Another option is based on quick relief treatment, also known as reliever or rescue medication, and is used to ease acute symptoms quickly (Papi et al., 2020). Quick relief treatment is only used when asthma symptoms occur, as patients consider it unnecessary the rest of the time (Papi et al., 2020).

Long-term control and quick relief medicine both help in asthma treatment, but in their usage are different.

Quick relief treatment and long-term control medications can have both positive and negative impacts on patients.

Long-term control can be identified as a long-acting beta-agonist (LABA) and can improve asthma symptoms and lung functions (Beasley et al., 2020). However, prolonged treatment with LABAs can promote tolerance to the effects of the medications or mask airway inflammation (Papi et al., 2020).

Quick relief treatment may be recognized as a short-acting beta-antagonist (SABA) and can cause relaxation of airway muscles by rapidly reducing airway bronchoconstriction (Papi et al., 2020). Nevertheless, SABAs are ineffective on the underlying inflammatory process and can be easily overused, increasing the risk of death from asthma in some cases (Papi et al., 2020).

Long-term control medications and quick relief treatment positively impact asthma symptoms but should not be overused.

Stepwise approach

Asthma treatment and management can be based on the stepwise approach.

The approach is described by Global Initiative for Asthma (GINA) guidelines and can be used to investigate and manage severe asthma (Beasley et al., 2020).

The stepwise approach is based on progressively increased treatment to achieve symptom control and possibly reduce medications with time (Beasley et al., 2020).

The basic premise implies that the symptoms are caused by asthma and can respond to asthma treatment (Beasley et al., 2020).

The approach focuses on targeting components of asthma that cause poor control and identifying alternative causes (Beasley et al., 2020).

The stepwise approach can be used for asthma treatment by gaining control over the symptoms.

Approaches for implementing the stepwise approach can be based on its algorithm.

The algorithm is presented by GINA and is currently based on inhaled corticosteroid (ICS) or formoterol reliever therapy combined with traditional SABA reliever therapy (Beasley et al., 2021).

The algorithm is aimed at adults and adolescents from twelve years old and consists of five steps (Beasley et al., 2021).

The stepwise approach implies up and down treatment adjustment based on individual patient needs using a preferred controller and preferred reliever (Beasley et al., 2021).

Each step has different levels of treatment, starting with a low dose, then increasing to medium and high doses, and eventually lowering the dose but considering the side effects (Beasley et al., 2021).

The stepwise approach algorithm is meant to control symptoms by varying the amount of treatment.

Stepwise management

The way stepwise management assists in gaining and maintaining control can be seen by looking at the stepwise approach.

The approach is focused on controlling the disease by managing and overcoming its symptoms (Beasley et al., 2020).

During treatment, stepwise management has to consider the needs of each patient and should be based on a partnership between health care providers and patients (Papi et al., 2020).

The stepwise approach is meant to assist management, especially in cases where patients and clinicians may aim for different goals due to various characteristics of each person’s health condition (Papi et al., 2020).

Stepwise management assists health care providers and patients in gaining and maintaining control of the disease by concentrating on each person’s symptoms and implementing individual treatment.

Stepwise management is control-based and should involve elements of personalized management of the stepwise approach.

The elements consist of assessment, adjustment, and review response (Papi et al., 2020).

The assessment is based on confirmation of the diagnosis and symptom control with the consideration of patient preferences and goals (Beasley et al., 2021).

The adjustment focuses on treatment and adjusting medications with the possible use of non-pharmacological strategies (Beasley et al., 2021).

The last element, review response, is based on addressing symptoms, exacerbations, side effects, and patient satisfaction (Beasley et al., 2021).

Stepwise management can assist control of the disease by focusing on treatment elements from the stepwise approach.


Beasley, R., Braithwaite, I., Semprini, A., Kearns, C., Weatherall, M., & Pavord, I. D. (2020). Optimal asthma control: Time for a new target. American Journal of Respiratory and Critical Care Medicine, 201(12), 1480-1487.

Beasley, R., Bruce, P., Hatter, L., Braithwaite, I., Semprini, A., Kearns, C., & Pavord, I. D. (2021). A proposed revision of the stepwise treatment algorithm in asthma. American Journal of Respiratory and Critical Care Medicine, 204(1), 100-103.

Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: Reshaping the concept of asthma management. Allergy, Asthma & Clinical Immunology, 16(1), 1-11.

Zahran, H. S., Bailey, C. M., Qin, X., & Johnson, C. (2017). Long-term control medication use and asthma control status among children and adults with asthma. Journal of Asthma, 54(10), 1065-1072.

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