Goals of asthma management. A step-care approach.

The past 15 years have seen a rise in mortality and morbidity resulting from asthma, despite a concurrent rise in general knowledge about the disease. The step-care strategy recognized these changes in its approach to asthma management; however, this approach should be used only with attempts to control environmental allergens. Step-care therapy requires that patients be categorized by the severity of illness. Step-one therapy is used for mild, infrequent symptoms and involves treatment based primarily on inhaled bronchodilators. Step-two therapy is instituted in all asthmatics except the mildest cases; it involves treatment by inhaled corticosteroids, cromolyn, or nedocromil. Step-three treatment targets cases of severe asthma through the use of oral corticosteroids. In all phases of treatment, however, it should be remembered that patient education is of critical importance. Education improves patient compliance and is critical to the successful treatment of asthma.