asthma

NAEPP: Updated Asthma Management Guidelines

The National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program Coordinating Committee have released new updates to their asthma management guidelines.

“It has been 13 years since the last revision of the asthma recommendations, and substantial progress has been made since that time in understanding the origins of asthma as well as its pathophysiology and treatment.,” the group wrote.

For this reason, they undertook an effort to update select high-priority topics, 17 of which were originally suggested, of which 6 had sufficient new data to warrant an update.

These topics included:

  • Fractional exhaled nitric oxide (FENO)
  • Remediation of indoor allergens
  • Adjustable medication dosing
  • Long-acting antimuscarinic agents
  • Immunotherapy
  • Bronchial thermoplasty

Among the recommendations:

  • FENO measurement should be added to the evaluation process in patients aged 5 years and older for whom diagnosis of asthma is uncertain.
  • Feno should not be used to predict future development of asthma in children aged 0 to 4 years with recurrent wheezing.
  • Allergen mitigation is conditionally recommended for patients with asthma and symptoms related to indoor allergen exposure confirmed by history or allergy testing.
  • Either daily low-dose inhaled corticosteroids (ICS) and as-needed short-acting beta-agonists (SABA) or as-needed ICS and SABA are recommended in individuals aged 12 years and older with mild persistent asthma.  
  • The panel conditionally recommends against adding Long-acting muscarinic antagonist (LAMA) to ICS compared with adding long-acting beta-agonists (LABA) to ICS in individuals aged 12 and older with uncontrolled persistent asthma.
  • Subcutaneous immunotherapy (SCIT) may be used as an adjunt treatment to standard pharmacotherapy in patients aged 5 years and older with mild to moderate allergic asthma that is controlled at the initiation, build-up, and maintenance phases of immunotherapy.
  • The panel conditionally recommends against bronchial thermoplasty in individuals aged 18 years and older with persistent asthma.

 

—Michael Potts

 

Reference:

Cloutier MM, Baptist AP, Teach SJ, et al; Expert Panel Working Group of the National Heart, Lung, and Blood Institute administered and coordinated National Asthma Education and Prevention Program Coordinating Committee. 2020 Focused updates to the asthma management guidelines: A report from the national asthma education and prevention program coordinating committee expert panel working group. JACI. 2020;146(6):1217-1270.