Asthma Awareness: A ‘Step Therapy’ Approach to Medications

Treating asthma is a dynamic process, the goal being controlled asthma, which interferes with your life to the smallest extent possible. In the quest to control asthma, medications are also important. The best approach is referred to as “step therapy,” which means searching for the correct level and combination of medications to keep your child’s asthma in control. Remember, when control is achieved you will need rescue medicine twice a week or less; nighttime asthma symptoms occur fewer than two times a month, and you will use fewer than two canisters of rescue inhaler in a given year.

Let’s look at how step therapy works.

Quick relief. The medication common to all treatment plans is the rescue or quick relief medication: short acting bronchodilators, used when acute symptoms such as cough, wheezing or chest tightness occur. A metered dose inhaler or nebulizer can deliver them. Albuterol and levalbuterol are the short acting rescue medications most commonly used today.

Anti-inflammatory. Medications are stepped up to the next level when treatment with short acting bronchodilators doesn’t suffice. Most commonly these are some type of inhaler steroid or anti-inflammatory inhaled drugs. Pulmicort, Flovent, and Asmanex are common brand names. Often times the medication known as Singulair (montelukast) is used instead of the inhaled steroids. Asthma in children can often controlled using just the first and second steps of therapy.

Combos. For those whose asthma still isn’t controlled, the next step is known as combination medications, which are the pairing of an inhaled steroid with a long acting bronchodilator. Common brand names include Symbicort, Dulera and Advair. This is the final step for most children, and no further steps up need to be taken.

Once control is achieved, your child should be maintained at this step for a period of time (my personal preference is 6-12 months) and then an attempt should be made to step down to the next lowest level of therapy. If successful, this level should again be continued for a period of time before attempting further reductions. The idea is always to use the least amount of medications while maintaining your child’s asthma in “controlled” mode. Again, this whole process is dynamic – after all, your little one is growing and changing every day – and must be individualized for each child treated.

Do you have questions about your child’s medication regimen? Share your concerns here, or, for further reference, check out the in-depth information on asthma medications in my book, Beating Asthma: Seven Simple Principles.

Thanks for reading. As always, I am interested in hearing your thoughts!

Published on: May 17, 2012
About the Author
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Dr. Stephen Apaliski is a practicing asthma and allergy specialist in Texas and author of the book Beating Asthma: Seven Simple Principles, which can be found in paperback on CreateSpace, through his website,

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