Bronchial asthma

Step care management of severe asthma:

 Step Care Management is like a staircase. We start treatment at the appropriate step. Then we shall step up along the stairs if asthma is not controlled or becomes more severe and shall step down when patient's asthma is fully controlled for 3 months or more.

We have divided the asthma management plan into five steps. At first, we should understand basic principles of five steps. Then we can construct any step by combining available drugs.

Basic Principles of Step Care Management

Step - I: Inflammation is so minimal that no Preventer or anti-inflammatory medication is required. Patient will only take Reliever drug (bronchodilator) as per need. Onwards Step-I is kept as a part of Step II to Step V.

Step - II: For control of inflammation, low dose Preventer (anti-inflammatory medication) is required. Reliever drug will be used in step-II to step-V as per need, like step-I. We can get desired low dose anti-inflammatory action by using "full dose Cromones" or "low dose Inhaled Corticosteroids (LDICS)" or “Leukotrienes antagonists”.

Step - III: To control airway inflammation, high dose Preventer (anti-inflammatory medication) is required. This means high dose inhaled Corticosteroids (HDICS). But we may give low dose inhaled Corticosteroids (LDICS) along with Cromones or long-acting b2-agonist (Salmeterol) inhaler or Sustained release Theophyllin (protectors) to get the desired effect. Any of these combinations is equivalent to high dose inhaled Corticosteroids (HDICS).

Step - IV: We have two divisions of step-IV viz. IVA and IVB. When high dose anti-inflammatory drugs (HDICS) are thought to be insufficient to control asthma then we use step - IVA or IVB. Step IVA (A=alone) means addition of either Salmeterol inhaler or Theophyllin SR alone with HDICS. Step IVB (B= both) means both Salmeterol inhaler and Theophyllin SR will be added with HDICS.

Step - V: It is the highest step. Oral Corticosteroid added as single morning dose with step-IVB is known as step-V. We give this step when step IVB is thought to be inadequate to control asthma.