Asthma: A Stepwise Approach to Treatment and Management


Today, asthma is one of the most critical health problems as it affects 235 million people globally (Papi et al., 2020). This disease is especially common and severe in people with low income, African-Americans, and women (Mauer & Taliercio, 2020). Since the pathophysiology of asthma is complicated, it requires ongoing treatment and management to minimize adverse effects and improve patients’ life quality.

For example, the case of a 50-year-old male with a history of heart attacks can be discussed in terms of implementing the stepwise approach for asthma treatment.

Quick-Relief Treatment

The first line of asthma treatment is quick relief, and national guidelines recommend short-acting beta-agonists (SABAs). Considering the identified patient, it should be noted that his excessive reliance on SABA leads to symptom deterioration, while the risk of death from asthma increases, as noted by Papi et al. (2020). Two other options for quick-relief treatment are as-needed inhaled corticosteroid (ICS)-formoterol or low-dose leukotriene receptor antagonist (LTRA). Among the side effects of the mentioned drugs, one should mention headache, increased heart rate, shakiness, et cetera. The identified patient-reported cardiovascular reactions after frequently inhaling SABAs.

Long-Term Control

Inhaled corticosteroids are to be used in combination with long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA), which ensures bronchodilation for up to 12 hours. However, the daily use of LABA can cause severe side effects, even though they are not common. As stated by “budesonide/formoterol is more effective in reducing severe exacerbation risk than as-needed salbutamol or maintenance budesonide plus salbutamol” (Beasley et al., 2019, p. 1485). For the given patient, a budesonide prescription can be associated with proper disease control, but his cardiac state should be monitored constantly to prevent heart attacks.

Stepwise Approach to Asthma

The core of a stepwise approach to treating asthma is achieving a well-controlled condition of a patient. According to the guidelines by the GINA, normal lung function and symptom control are two key goals to achieve for the given patient (Mauer & Taliercio, 2020). Considering the mild severity of his asthma, one may conclude that he needs step three, namely, low-dose ICS-LABA or medium-dose ICS, or low-dose ICS + leukotriene receptor antagonist (LTRA). The given patient may receive step two or step three treatment options, depending on the future course of his disease.

In turn, based on the review of the recent studies, Beasley et al. (2020) propose a biomarker-driven approach to implementing the stepwise approach to asthma treatment and management. In particular, the above authors claim that biomarkers of type 2 airway inflammation are more representative of the patient’s health condition. It is expected that the application of the proposed approach would allow for clarifying asthma-related risks more effectively compared to the current guidelines by the GINA.

Value of Stepwise Approach: Health Care Providers

For healthcare providers, such an approach is a promising way to achieve higher diagnosing and treatment effectiveness. By implementing the cycle of three components (review-response, assess, and adjust), they can provide personalized asthma care, namely, change treatment up and down as needed. The ongoing confirmation of diagnosis implies modifying treatment prescriptions, which allows for controlling not only symptoms but also risks.

In addition, a lack of proper attention to a patient’s comorbid diseases and symptoms can make the process of treatment ineffective. Therefore, the role of overlapping disorders, mental health, lifestyles, environment, and other specific issues should be taken into account (Beasley et al., 2020).


Research shows that many patients use their prescribed medications only if asthma symptoms appear (Beasley et al., 2019). Nanda et al. (2020) argue that in older adults, measuring asthma symptoms and risks is complex since they often disregard the necessity of self-monitoring. Such a low adherence to therapy leads to complications that could have been potentially avoided. In this regard, the stepwise approach is essential to ensure that patients would strictly follow therapeutic guidelines. The value of this approach is associated with increasing patient awareness and combining quick-relief treatment and long-term control options. The implementation of stepwise asthma management would ensure that the given patient minimizes the side effects of medication while achieving the best possible life quality.


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., Harper, J., Bird, G., Maijers, I., Weatherall, M., & Pavord, I. D. (2019). Inhaled corticosteroid therapy in adult asthma. Time for a new therapeutic dose terminology. American Journal of Respiratory and Critical Care Medicine, 199(12), 1471-1477.

Mauer, Y., & Taliercio, R. M. (2020). Managing adult asthma: The 2019 GINA guidelines. Cleveland Clinic Journal of Medicine, 87(9), 569-575.

Nanda, A., Baptist, A. P., Divekar, R., Parikh, N., Seggev, J. S., Yusin, J. S., & Nyenhuis, S. M. (2020). Asthma in the older adult. Journal of Asthma, 57(3), 241-252.

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.

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