Asthma and Step wise Management

 Asthma and Step wise Management

Asthma and Step wise 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.Asthma and Step wise Management
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.
Review Chapter 25 of the Arcangelo and Peterson text. Reflect on using the step wise approach to asthma treatment and management.
Consider how step wise management assists health care providers and patients in gaining and maintaining control of the disease.
By Day 7
Write a 2- to 3- 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 step wise approach to asthma treatment and management.
Explain how step wise management assists health care providers and patients in gaining and maintaining control of the disease.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at All papers submitted must use this formatting.

Theses are possible resources. The requirement is 2-3 course resources and 2 current outside resources. Required Readings Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. Chapter 18, “Otitis Media and Otitis Externa” (pp. 243-252) This chapter compares the causes and pathophysiology of two common ear infections—otitis media and otitis externa. It also identifies types of drugs used to treat these ear infections. Chapter 24, “Upper Respiratory Infections” (pp. 259-374) This chapter explores the causes, pathophysiology, and diagnostic criteria of two upper respiratory infections—the common cold and sinusitis—as well as drug therapy for both infections. It also covers monitoring patient response and patient education of drug therapy for these infections. Chapter 25, “Asthma” (pp. 377-392) This chapter examines the causes, pathophysiology, pharmacogenomics, and diagnostic criteria of asthma. It also outlines suggested drug therapy plans for asthmatic patients. Chapter 26, “Chronic Obstructive Pulmonary Disease” (pp. 395-406) This chapter explains the causes and pathophysiology of chronic obstructive pulmonary disease (COPD). It also examines the process of selecting, administering, and managing drug therapy for COPD patients. Chapter 27, “Bronchitis and Pneumonia” (pp. 407-424) This chapter begins by examining the causes, pathophysiology, and diagnostic criteria of acute bronchitis, chronic bronchitis, and community-acquired pneumonia. It then explores the process of selecting, administering, and managing drug therapy for patients with bronchitis and pneumonia. Asthma and Step wise Management


            This paper discusses how asthma can be controlled in the long term and how patients who might experience an asthma attack can attain quick relief from short-acting medications. It also explains the stepwise approach to the management of asthma and how benefits both patients and healthcare providers in maintaining disease control.

Long-term Control and Quick Relief Treatment Options for Asthma Patients and the Impact of Asthma Drugs on Patients

Long term Control

The long term goal of asthma therapy is to reduce the frequency of occurrence and severity of asthma symptoms. However, in order to attain this long term control, it is mandatory that medications are taken on a daily basis  Medications used for long term asthmatic control according to the FDA are long-acting beta agonists(LABA), inhaled corticosteroids(ICS) or a combination of both, theophylline and leukotriene modifiers. Amongst them all, inhaled corticosteroids have proven to be the most effective in long term asthma control (Arcangelo, et al., 2017). It acts by preventing the hyperresponsiveness of the airways to improve the severity of symptoms and restoring the functioning of the respiratory system. Some of the scientifically identified impacts of inhaled corticosteroids to patients include easy bruising, oral thrust, a cough, osteoporosis, and hoarseness of the voice. Therefore, when patients are placed under medications, it is essential that they are closely monitored for any worsening side effects (Arcangelo, et al., 2017).Asthma and Step wise Management


Quick Relief

Quick-relief medications for asthma are commonly also referred to as rescue drugs. They are used in the management and control of symptoms such as severe coughs, shortness of breath and wheezing during an asthma attack. Quick-relief medications are also referred to as bronchodilators due to the relaxation they cause on the muscles of the airways. This explains why is it essential for all patients to be educated on the essence of keeping a rescue inhaler at all places/times since they have a very short and fast acting duration to manage attacks and improve breathing as compared to the drugs used for long-term control (Khalid, 2015).  Perfect examples of quick-relief medications include albuterol, bitolterol, pirbuterol, and metaproterenol. The most significant side effects caused by these drugs include anxiety, tremors, headaches, irregular heartbeat, and restlessness.

Stepwise Approach to Asthma Treatment and Management

            Immediately a diagnosis of asthma is made and the extent of severity of the condition is made, an APN will use the stepwise approach to make a clinical decision on the step of therapy that suits a client best based on the severity level of his/her asthma. The stepwise approach should, however, be adjusted and implemented according to the guidelines provided in the Expert Panel Report 3 by the National Asthma Education and Prevention Program (NAEPP EPR-3). Its major purpose is to ensure that a more intense therapeutic approach is initiated and that a patient’s symptoms can rapidly be controlled before stepping down to the least therapy. It comprises of six steps as follows (National & Prevention, 2007).

In step one; a short-acting beta-agonist is used in the management of intermittent asthma. In step two to six, patients with persistent asthma are managed using daily drugs. Therefore, in step two, low-dose inhaled corticosteroids are prescribed. In step three; either low dose Long-Acting Beta Agonists (LABA) or medium-dose inhaled corticosteroids are used (Khalid, 2015). In step four, both medium doses inhaled corticosteroids and long-acting beta agonists are used. In step five, a patient is managed with a long-acting beta agonist and a high-dose inhaled corticosteroid. Lastly, in step six, a long-acting beta agonist, an oral corticosteroid and a high-dose inhaled corticosteroid are all used (Khalid, 2015).

How Stepwise Management Helps Healthcare Providers and Patients to Gain and Maintain Disease Control

            In the management of asthma, the stepwise approach is a highly effective tool that is used by both the patient and healthcare provider.  When used by healthcare providers in the form of questionnaires, healthcare personnel can easily determine the extent to which the condition has been able to be controlled. Based on these findings, healthcare personnel can easily tell whether or not medications currently being used by a patient are effective and of significance to a patient (Arcangelo et al., 2017).  This is attributed to the fact in managing asthmatic patients; the disease stage is a determining factor that guides the medications to be prescribed and alternative medications that can be used. Patients benefit from the fact that in each stage, any underlying comorbidities that a patient may have are also managed, he/she also received education and efforts to achieved environmental control are established, which generally leads to good health outcomes (Arcangelo et al., 2017).Asthma and Step wise Management


Asthma affects both adult and young populations. It presents significant challenges of short term and long term control to healthcare providers in primary care settings. However, the stepwise approach is an effective tool that providers can utilize for good patient outcomes in the long term control and management of asthma. Before management, it is necessary that a patient’s potential triggers are first identified as this will also guide patient education.


Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. Chapter 25, “Asthma” (pp. 377-392)

Khalid, A. N. (2015). Stepwise management of asthma. In the International forum of allergy & rhinology (Vol. 5, No. S1, pp. S41-S44).

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 immunology120(5 Suppl), S94.Asthma and Step wise Management