Step therapy of bronchial asthma

Stepwise therapy of bronchial asthma is a set of measures aimed at getting rid of pathology and minimizing its symptoms. In total, therapy is divided into 5 levels, each of which has a specific role. The advantage of this treatment is that the disease is controlled with a minimum of drugs.

Features of stepwise asthma treatment

The disease can occur at any age, and it often becomes chronic. It cannot be completely cured, but it is possible to reduce the manifestation of symptoms and strengthen the patient’s immunity.

The basic principles of therapy include:

  • choosing the best scheme of treatment, the doctor listens to the patient’s wishes;
  • control of the course of the disease, monitoring of the patient’s condition;
  • adjusting the course of therapy;
  • going one step higher with zero therapeutic effect;
  • moving to a lower level if asthma is controlled for at least 3 months;
  • if the disease is of moderate severity, and the basic therapy was not carried out, then the 1st stage is skipped, and treatment starts from the 2nd;
  • if asthma is uncontrollable, then it is necessary to start therapy with the 3rd stage;
  • emergency medications are used if necessary.

At each stage in the therapy of bronchial asthma, the patient must undergo certain diagnostic procedures in order to stop the manifestations of the disease and prevent complications. It is also necessary to determine the appropriate pharmaceutical preparations, because adverse reactions are likely to occur.

In adults

Since the adult body is more resistant to the active substances in asthma medications, the doctor increases the dosage in accordance with the standards. Of course, during pregnancy or in the presence of contraindications, therapy is adjusted.

It is somewhat easier to treat adult patients, since they react to changes in well-being and can notify the doctor in time. Moreover, in addition to drug treatment, the patient can be prescribed physiotherapeutic procedures: massages, acupuncture, thermotherapy.

In children

Pediatrics allows children to use drugs for adults. At the first stage of treatment, bronchodilators and short-acting adrenostimulants are used . At the second stage, inhaled glucocorticosteroids (ICS) are included in low dosages, but if relief does not come within 3 months, then the dose is increased. In acute attacks of bronchial asthma, hormonal drugs are prescribed , but they are not taken for long.

At the third and fourth stages, the dosage of ICS is increased, and adrenostimulants are added to the nebulizer solution .

Adults should teach a child how to use the inhaler as the device needs to be used regularly.

Five steps of treatment

To prescribe an appropriate course of therapy, the doctor needs to determine the level of disease control using the GINA chart . The classification of bronchial asthma divides the disease into 3 types:

  • Controlled. The patient has seizures a couple of times a week, and no exacerbations or disturbances are observed.
  • Persistent . Asthma symptoms make themselves felt more often than once every couple of days, and they can also appear at any time of the day.
  • Heavy. Attacks occur around the clock and quite often. Lung function is impaired, and asthma worsens every 7 to 10 days.

According to the classification, the doctor determines the level of therapy. Moreover, emergency medications are used at any stage.

The patient’s condition is monitored every 3 months, and if exacerbations occur, then the frequency is reduced to 1 month. The patient can be transferred to a step lower, but only from levels 2 and 3. At the same time, the changes relate to the amount and dosage of drugs, and emergency funds are left.

It must be remembered that self-treatment is prohibited, since only a doctor is competent enough in determining suitable medicines. You need to follow the recipe and control your own health.

The first

This stage includes patients who have mild asthma. Symptoms are sporadic, and exacerbations are rare. The respiratory organs are functioning normally.

The main methods of treatment in the first stage are as follows:

  • It is necessary to avoid irritants and not to contact them.
  • As a quick way to get rid of symptoms, inhalations with Salbutamol , Fenoterol, Terbutalin are used .
  • Before training or interacting with an allergen, you should use Cromolin sodium or short-acting P2-adrenergic agonists.

If the symptoms become more pronounced, the doctor should consider transferring the patient to stage 2 of bronchial asthma treatment.

The second

The course of the disease is also mild, but the frequency of exacerbations and manifestations of symptoms increases: more than 1 time per week. The signs are constant, not very pronounced.

Following a stepwise approach, the doctor prescribes the use of anti-inflammatory aerosols. Suitable corticosteroids for inhalation or Cromolin sodium, which is available in powder for dissolution. He also prescribes Ketotifen for oral administration.

If a therapeutic effect is not observed, then the dosage of corticosteroids is increased in the absence of contraindications on the part of the patient, and the following medications are also included:

  • bronchodilators Volmax Salmeterol ;
  • Theo- Dur Teotard Filokontin and other preparations of the 1st and 2nd generation, the main active ingredient of which is theophylline;
  • P2-short-acting adrenergic agonists for inhalation.

If symptoms persist during sleep, the patient is transferred to stage 3.


Chronic asthma is of moderate severity. Symptoms are observed every day, a couple of times a week the patient suffers from night attacks.

In therapeutic measures, the doctor increases the daily dose of drugs to combat inflammation, however, when the dosage is increased, the patient needs to be constantly under the supervision of a doctor to avoid adverse reactions.

For night symptoms, the patient is prescribed long-acting Theophylline preparations of the 1st and 2nd generation. P2 agonists, which give a prolonged effect, also help. Also used are Troventol and Ipratropium Bromide.


Asthmatics are transferred to this stage, in whom the disease has acquired a severe course with frequent exacerbations. During the day, symptoms are constant, and at night they appear from time to time.

Similar to the previous steps, the doctor will increase the dosage of anti-inflammatory drugs. Also, drugs based on theophylline I and II generation of sustained release are used, however, the dose of the drugs taken does not increase.

Inhaled and oral P2-adrenergic agonists fight against nighttime attacks:

The fifth

At this stage, the same means are used as in the fourth, but hormonal drugs of systemic action for oral administration are included in the therapy. They can relieve symptoms and make you feel better, but they have a number of serious negative reactions. Also, antibodies to IgE are needed in the form of injections administered subcutaneously.

Treatment of bronchial asthma is a complex procedure that requires an integrated and stepwise approach. Thanks to the standardized method of step-by-step therapy, the patient can significantly alleviate the symptoms of the disease, up to their almost complete disappearance. However, for a successful result, you need to strictly follow the doctor’s recommendations and not take the initiative.

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