Asthma and Stepwise Management 2

Asthma

Asthma is a disease characterized by airway hyperresponsiveness and narrowing as a 

result of allergic reactions leading to diffuse airway inflammation (Arcangelo, Peterson, Wilbur, 

& Reinhold, 2017). The inflammation is caused by a variety of triggering stimuli resulting in 

partially or completely reversible bronchoconstriction. Signs and symptoms include dyspnea, 

chest tightness, cough, and wheezing. The diagnosis is based on history, physical examination, 

and pulmonary function tests. Treatment involves controlling triggering factors and quick 

symptomatic relief using drug therapy, most commonly with inhaled beta-2agonists and inhaled 

corticosteroids (Ortega & Pennington, 2017). Acute asthma exacerbation is considered a lifethreatening emergency and often requires hospital admission, the goal of asthma exacerbation 

treatment is to control symptoms and return patients to their best lung function, often using 

inhaled bronchodilators and systemic corticosteroids (Ortega & Pennington, 2017). 

Approximately 25.7 million people suffer from asthma in the U.S., it results in around 9 deaths 

per day, and costs $56 billion per year in treatment (Arcangelo, Peterson, Wilbur, & Reinhold, 

2017; CDC, 2013). The purpose of this paper is to examine medication options for long-term 

control and quick relief, and to understand the stepwise approach to asthma treatment and 

management.

Medication Options

Proper care of patients with asthma involves the triad of systematic chronic care plans, 

self-management support, and appropriate medical therapy. Controller medications (inhaled 

corticosteroids, long-acting beta2 agonists, and leukotriene receptor antagonists) are the 

foundation of care for persistent asthma and should be taken daily on a long-term basis to 

Asthma and Stepwise Management 3

achieve and maintain control of symptoms. Inhaled corticosteroids are the preferred controller 

medication; studies have demonstrated that when inhaled corticosteroids are used consistently, 

they improve asthma control more effectively than any other single long-term control 

medication. Combining long-acting beta2 agonists and inhaled corticosteroids is effective and 

safe when inhaled corticosteroids alone are insufficient, and such combinations are an alternative 

to increasing the dosage of inhaled corticosteroids (Kurtis & Pollart, 2010).

Major drug classes commonly used in the treatment of asthma include beta-2 adrenergic 

agonists, corticosteroids, leukotriene modifiers, mast cell stabilizers, methylxanthines, and 

immunomodulators (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Drugs in these classes are 

inhaled, taken orally, or injected subcutaneously or intravenously.

Beta-2 adrenergic agonists relax bronchial smooth muscle, decrease mast cell 

degranulation and histamine release, inhibit microvascular leakage into the airways, and increase 

mucociliary clearance. Beta-2 agonist preparations may be short-acting, long-acting, or ultra–

long-acting (Arcangelo, Peterson, Wilbur, & Reinhold, 2017; Ortega & Pennington, 2017). 

Albuterol is a short-acting beta-2 agonist taken by inhalation every 4-6 hours. Salmeterol and 

formoterol are long-term beta-2 agonists and are usually taken by inhalation in combination with 

inhaled corticosteroids two times daily. Side effects of beta-2 agonists include tachycardia, 

skeletal muscle tremor, nervousness, hypokalemia, and hyperglycemia.

Corticosteroids inhibit airway inflammation, reverse beta-receptor down-regulation, and 

inhibit cytokine production and adhesion protein activation. Routes of administration include 

oral, IV, and inhalation (Drugs.com, 2017; Ortega & Pennington, 2017). Beclomethasone, 

budesonide, and fluticasone are examples of inhaled corticosteroids. These agents are used for 

long-term control of symptoms, not as a quick relief option; adverse effects of these drugs 

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include oral candidiasis and hoarseness of voice (Arcangelo, Peterson, Wilbur, & Reinhold, 

2017). Prednisone is an example of oral corticosteroids, adverse effects of oral corticosteroids 

include sodium and water retention, weight gain, increased appetite, and peptic ulcers 

(Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Combination inhaled corticosteroids and long-acting beta-2 adrenergic agonists are 

used together due to their synergistic effect which allows for lower dose of corticosteroids 

(Ortega & Pennington, 2017). Examples of combination drugs include formoterol, salmeterol, 

and vilanterol in conjunction with fluticasone, budesonide, or mometasone (Arcangelo, Peterson, 

Wilbur, & Reinhold, 2017).