A person using an inhaler.
Asthma step therapy is when a doctor uses an algorithm to increase or decrease a medication dose for patients.

Asthma Step Therapy Overview

Asthma is a chronic lung disease that affects millions of people in the U.S. When someone is first diagnosed with the condition, it may take a little trial and error to determine the right treatment plan to control symptoms. Some doctors use asthma step therapy, also called the stepwise approach.

What is Asthma Step Therapy?

Asthma step therapy is an approach to treating asthma in both children and adults. The step therapy method allows your doctor to follow an algorithm to increase or decrease the medications and doses based on your response.

While your doctor wants to control symptoms to prevent an asthma attack, medications can also have side effects. The goal of asthma step therapy is to find the right balance of medications to control symptoms by adjusting dosages up and down.

How is Asthma Step Therapy Used?

Asthma step therapy is used as a guide to finding the right balance of medication to treat asthma. It can be implemented with patients of any age. But because some of the recommendations in some steps are for people over the age of 12, it may be best for teens and adults.

The way it works is when a person is first diagnosed with asthma, medications are prescribed in certain doses, and different classifications of drugs may be added until asthma appears controlled.

To determine if a person’s asthma is well controlled, doctors consider a few factors. For example, your doctor considers the frequency of attacks, the severity of symptoms, and whether hospitalization was needed. Your doctor may also consider whether asthma symptoms are interfering with sleeping at night or being active during the day.

Once symptoms are controlled, you work with your doctor to adjust treatment to the least amount of medications needed to maintain continuous control of symptoms.

Pros and Cons of Asthma Step Therapy

Like many aspects of medicine, there are both pros and cons to using asthma step therapy.

The pros:

  • Requires carefully ongoing monitoring: With a step approach, patients are continually assessed to determine if they should step up or down with treatment.
  • May reduce side effects: By following a set of guidelines that take a gradual approach to increasing medications, it may reduce side effects from taking higher doses.
  • May decrease the risk of overtreatment: Adjusting down may prevent patients from continuing to take medications they do not need.
You May Also Like

The cons:

  • May promote a one-size-fits-all approach: By following steps, it may remove some of the variations that require clinical judgment. Not every patient will fit into a specific step.
  • Involves increasing the dose of steroids: The increasing dose of steroids as part of asthma step therapy can lead to certain side effects, such as thinning skin and bruising in older adults.
  • May not work for children under 12: Step three and above involve recommendations that do not apply to children under the age of 12.

Asthma Step Therapy Process

The National Expert Panel developed an asthma step therapy plan to maintain asthma control with the least amount of medications.

The process of asthma step therapy usually involves six steps. After a few weeks, if asthma symptoms are not well controlled with step one of treatment, patients move up to the next step. At the direction of their doctor, patients keep moving to the subsequent step if symptoms persist.

When symptoms are well controlled for a few months, they may move down to a previous step.

The first two steps are for patients of all ages. Steps three through six are indicated for patients 12 years and older.

Step one: Step one is for intermittent asthma symptoms. It involves taking a short-acting beta-agonist as needed to relax the muscles of the airways. This class of medications will help reduce wheezing and chest tightness.

Step two: People who have persistent asthma will move into step two, which includes adding a low dose of inhaled corticosteroid to reduce inflammation in the lungs and control asthma symptoms.

Step three: Step three involves either increasing the dose of inhaled corticosteroid or keeping the steroid at a low dose and adding a low dose long-acting beta-agonist bronchodilator. Once individuals need to move to step three, they should consult an asthma specialist.

Step four: Step four involves taking a medium dose of inhaled steroid and increasing the dose of a long-acting beta-agonist bronchodilator to a medium dose.

Step five: When a person’s asthma is still not controlled after moving to step four, the dose of steroid and long-acting bronchodilator is increased to a higher dosage. In this stage, an additional classification of medication is also recommended. Omalizumab is a drug that binds to IgE antibodies. IgE antibodies play a role in allergic reactions and may affect people with allergic asthma. By blocking the effect of the antibodies, the medications may help treat people with moderate to severe allergic asthma.

Step six: Step six involves taking high doses of long-acting bronchodilators and inhaled corticosteroids, along with oral steroids and possibly Omalizumab.

Final Notes

It is vital that people with asthma do not adjust down from one step without talking with their doctor. It is also critical that people with asthma take the medications as directed.