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Asthma and Stepwise Management
Introduction
Asthma is chronic respiratory disease that needs to be controlled and managed appropriately to minimize risk of airway obstruction and death in some cases. Quick relief and long-term treatment interventions for asthma and their impacts on patients are discussed in this paper. Besides, stepwise management tool and how to use it is also discussed in this paper.
Quick Relief and Long-Term Control Treatment of Asthma
Quick relief medications provide immediate relief from asthma episodes and attacks. Quick relief medications include short-acting beta-2-agonists such as levalbuterol, albuterol, metaproterenol and epinephrine (Felman, 2018). Care must be observed to avoid overuse of should be observed. Long-term use of quick relief medications may result into side-effects such as heightened risk of asthma exacerbation, poor symptom control, and death due to asthma in patients across all age groups (Thomson, 2015).
Long-term control of asthma strives to reduce the level of airway inflammation and to prevent emergence of asthma symptoms. Asthma patients use long-term control medications to treat ongoing symptoms and to reduce flare-ups. Inhaled corticosteroids are common long-term control medications used for management of asthma. Inhaled corticosteroids help reduce an individual’s sensitivity to asthma triggers and allergens. However, inhaled corticosteroids tend to cause side effects such as throat and mouth thrash to children, adolescent as well as adult patients. Besides, long term use if inhaled corticosteroids for a long time may increase the risk of osteoporosis and cataracts to asthma patients (Felman, 2018).

Asthma Stepwise Approach
Stepwise approach for management of asthma entails six steps that are followed in the step-up manner (1-6) and step -down manner. Step-up manner is adhered to manage continuously worsening cases of asthma. Conversely, step-down approach is adhered to when asthma conditions seem to respond well to treatment with reduced degree of symptoms and low risk of exacerbations. Specific medications and other appropriate interventions are provided at different steps; specific for different age groups (Arcangelo et al., 2017).

How Stepwise Approach can be used by Patients and Healthcare Providers to Gain and Maintain Control of Asthma
Stepwise tool provides evidence-based guidelines for helping healthcare providers and patients gain control and mange asthma. Step 1 guidelines are appropriate for patients of all ages for use for management of intermittent asthma. Treatment includes use of short-acting beta-agonists; although they must not be used more than 2 days per weeks. If Step 1 therapeutic plan is not effective then the treatment plan should be stepped-up (Arcangelo et al., 2017).
In Step 2, a leukotriene blocker, cryomolyn or a low-dose inhaled steroid may be used by patients of all ages. Patents aged 0 to 4 years may be considered for referral; especially if the diagnosis is not affirmative. In Step 3, a low-dose inhaled steroid together with a long-acting beta-agonist of a medium dose inhaled steroid is recommended for patients aged 12 years and more. Alternatively, a leukotriene blocker in addition to a low dose inhaled steroid can be considered for patients aged 12 years and more. Besides in Step 3, patients aged 5 to 11 years are provided with a long-acting beta-agonist and a low-dose inhaled steroid or a medium-dose inhaled steroid or a leukotriene blocker; whereas, those aged 0 to 4 years are provided with a medium-dose inhaled steroid together with a referral (Arcangelo et al., 2017).
In Step 4, patients aged 5 years and more are provided with a long-acting beta-agonist and a medium-dose inhaled steroid or else a leukotriene blocker together with a medium-dose inhaled steroid. Patients aged 0 to 4 years should use a leukotriene blocker or long-acting beta-agonists together with a medium-dose inhaled steroid. In Step 5, patients aged 12 years and more are provide with omaluzimab in case of allergies, a long acting beta-agonist and high-dose inhaled steroid; whereas, those aged 5 to 11 years are provided with a high-dose inhaled steroid and a long-acting beta-agonist or a leukotriene blocker and high-dose inhaled steroid. Those aged 0 to 4 years are provided with a long-acting beta-agonist or a leukotriene blocker together with a high-dose inhaled steroid (Arcangelo et al., 2017).
In Step 6, patients aged 12 years and more are provided with omaluzimab in case of allergies, a high-dose inhaled steroid, long-acting beta-agonist, and oral steroid. Patients aged 5 to 11years are provided with a long-acting beta-agonist and high-dose inhaled steroid or alternatively oral steroid, high-dose inhaled steroid, and a leukotriene blocker. Those aged 0-4 years are treated with an oral steroid, high-dose inhaled-steroid, and a leukotriene blocker or a long-acting beta-agonist. Step 4-6 requires advice from an asthma specialist; whereas, step 2-4 requires consideration of immunotherapy if asthma due to allergy is diagnosed (Arcangelo et al., 2017).
Conclusion
Patients, families, and families need be educated about the side effects and appropriate use of quick relief and long-term asthma medications. Patients and healthcare providers should learn about Stepwise approach to use to achieve adequate control and management of asthma. Quick relief and long-term medications should be used depending on symptoms and level of disease exacerbations as guided by the Stepwise tool.