Goals of asthma management. A step-care approach

Chest. 1996 Apr;109(4):1056-65. doi: 10.1378/chest.109.4.1056.


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.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Administration, Oral
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Allergens
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy*
  • Asthma / prevention & control
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use
  • Clinical Protocols
  • Cromolyn Sodium / administration & dosage
  • Cromolyn Sodium / therapeutic use
  • Environmental Exposure
  • Goals
  • Humans
  • Nedocromil / administration & dosage
  • Nedocromil / therapeutic use
  • Patient Compliance
  • Patient Education as Topic
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Allergens
  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Nedocromil
  • Cromolyn Sodium