Asthma Stepwise Approach

Asthma The stepwise approach

Asthma Stepwise Approach

All health professionals follow the asthma stepwise approach to medical treatment of asthma. The position on the asthma stepwise approach scale is not fixed as improvement in asthma symptoms can mean the movement of the childs place on the scale. Basically your child will be given a step between on and five on a scale to measure the severity of their asthma.

Step one

Mild Intermittent Asthma

Mild intermittent asthma is where the signs an symptoms of asthma are mild and infrequent. A relieving inhaler that contains a short-acting beta2-agonist should be enough to contain their asthma. This works for up to six hours taking action after five minutes of inhaling. It works by reducing the amount of sticky mucus that is produced as it relaxes the muscles around the bronchi airways to prevent the chest tightening.

Step two

Regular Preventer Therapy

Regular preventer therapy is used when your child shows signs and symptoms of asthma more than twice within a one week period, usually the child wakes up in the night coughing and wheezing. It is also used if your child has suffered an asthma attack within the previous two years or has to use a short-acting beta2 agonist inhaler more than two times in a one week period. Preventer medications will be used to treat your child which are inhalers that contain a corticosteroid. The corticosteroid inhaler should be used twice daily to prevent triggers. Corticosteroids are known to reduce inflammation in the bronchi airways therefore preventing asthma attacks from taking place. On some occasions oral thrush can appear in the mouth after using corticosteroids therefore a good swill out after using the inhaler can help, but brushing teeth is much better as a preventative of oral thrush.

Step 3

Add-On Therapy

Add on therapy is used when your childs asthma symptoms are unresponsive with steps one and two of the stepwise approach. Another preventer inhaler will be issued in conjunction with the first one. This additional inhaler contains a long-acting beta2-agonist. The only difference in comparison to the short-acting beta2bagonist is that the long-acting beta2 agonist is that the long-acting beta2 agonist takes a longer time to act but can last up to twelve hours longer. Should your symptoms still persist then the corticosteroid dosage can be increased. Prolonged usage of corticosteroids can actuall increase the risk of an asthma attack so you should always take the prescribed dosage when needed. Children below the age of two years old will need to be referred to a child asthma specialist.

Step 4

Persistent Poor Control

Persistant poor control of asthma will lead to further preventative measures usually in one or two forms. The first is Leukotriene receptor antagonists which are a tablet form medication that blocks the chemical reaction leading up to inflammation of the bronchi airways. The second is Theophyllines which are an oral medication that widens the muscles surrounding the bronchi airways by relaxing these muscles. Known side affects of taking theophylines are headaches, insomnia, nausea or vomiting, stomach aches and irritability. Children below the age of five years old should be referred to a child asthma specialist.

Step 5

Continuous or Frequent use of Oral Steroids

Continuous or frequent use of oral steroids is the final step in the stepwise approach to preventing asthma attacks. Oral steroids will be issued to control the asthma. Referral for all children should be made to a child asthma specialist. Continuous or frequent use of oral steroids really is the last type of treatment of asthma because prolonged uses of oral steroids comes with more serious side effects such as ostoporosis (fragile and brittle bones), hypertension (high blood pressure) and possibly even diabetes and cataracts (disorder of the eye , clouding of the lens) when more than three months usage of oral steroids is taken. Regular check ups will be necessary to monitor these possible side effects. Supplements can be taken in addition such as Calcium and Vitamin D (to strengthen bone structure). Prolonged usage of oral steroids has been known to restrict the normal growth of some children.