The action of corticosteroids is to help reduce

The action of corticosteroids is to help reduce airway inflammation by inhibiting or
inducing the production of end-effector proteins (Arcangelo et al., 2017). Leukotriene modifiers
block the action of leukotrienes, one cause of the inflammation and nasal congestion associated
with allergies (Arcangelo et al., 2017). For patients with asthma, leukotriene modifiers help keep
the bronchial tubes from constricting (Arcangelo et al., 2017). Beta-adrenergic agonists
stimulate beta-adrenergic receptors that increase the production of cyclic 3’ 5 adenosine
monophosphate (cAMP) (Arcangelo et al., 2017). The increase in cAMP relaxes airway smooth
muscles and increases bronchial ciliary activity (Arcangelo et al., 2017). Theophylline
bronchodilators relax the bronchial smooth muscle, the enhance contractility of the diaphragm
and have a slight anti-inflammatory effect (Arcangelo et al., 2017).
Short-acting beta agonists (SABA) are inhaled bronchodilators that provide quick-relief
and act within minutes to help ease the symptoms of an asthma attack. Albuterol treats and
prevents bronchospasm due to a reversible obstructive airway disease by stimulating beta-
adrenergic receptors in the lungs that results in the relaxation of bronchial smooth
muscle (Kizior, Hodgson, Hodgson, & Witmer, 2017). Atrovent is an inhalation and nebulizer
maintenance treatment of bronchospasm by blocking the action of acetylcholine at the
parasympathetic sites in bronchial smooth muscle (Kizior et al., 2017).
Stepwise Approach
Beyond diagnosing for asthma, the first step is to classify its severity. Classifying the
severity of asthma is based on two characteristics: impairment and risk (Holt, 2009). Impairment
refers to the review of symptoms the patient is currently experiencing, the frequency of SABA

ASTHMA AND STEPWISE MANAGEMENT 4
use, the results of spirometry, number of times patient wakes up at night, and the degree of daily
activity limitations (Holt, 2009). Risk refers to that of future exacerbation of asthma attacks,
based on the number of previous attacks and the need for increases of systemic
corticosteroids (Holt, 2009).
The stepwise approach was developed for managing asthma in youths through 12 years
of age and adults (Holt, 2009). It is a six-step process to help manage medication treatments
based on the patient’s classification of severity and risk (Holt, 2009). Step 1 of therapy would
consist of a SABA prn because the patient has only intermittent symptoms, this is the only
treatment necessary. Mild persistent asthma symptoms should be treated with a low-dose inhaled