According to Duff, Neff and Maurer (2017), a stepwise approach maximizes quality of life while minimizing morbidity and is based on a careful assessment of frequency of symptoms,
ASTHMA AND STEPWISE MANAGEMENT 4 forced expiratory volume in one second (FEV1), and the frequency of exacerbations in the past year requiring systemic steroids. Step 1 according to Arcangelo and Peterson (2013) is for patients whose symptoms are no more than twice a week in the daytime and not more than twice a month during the night. The treatment is solely on inhaled SABA as needed with no daily maintenance medication. If a beta2 adrenergic agonist is used in a month, patient will need to move up to step 2. Step 2 consists of a low-dose inhaled corticosteroid at which stage patient moves up to step 3 if symptoms are not controlled. Step 3 consists of a combination of a LABA and a low-dose corticosteroid or a medium- dose corticosteroid. Another alternative would be drugs such as a leukotriene modifier. Patient moves to step 4 if symptoms are not relieved. Step 4 includes a LABA and a medium-dose corticosteroid. An oral corticosteroid can be used as needed with the alternative of adding a leukotriene modifier. Step 5 consists of a LABA and a high-dose inhaled corticosteroid. In addition to the treatment for step 5, step 6 includes an oral corticosteroid. Stepwise Management and Asthma Control The stepwise approach is a great way of making sure that both the patient and providers are monitoring the patient’s response to treatment in order to gain maximum symptom control. The goal is disease control, maintenance of normal lung function and activity. The physician should regularly assess the patient for symptom control to determine whether to step up or down on treatment. The recommendation for follow-up according to Duff, Neff and Maurer (2017) is every 6 months or less if symptoms are not well controlled.
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- Summer '15
- bronchial asthma