New updates to federal guidelines revamp asthma management

Updates to six key areas of asthma care focus on improving diagnosis, management and treatment

The National Institutes of Health today announced 19 recommendations in six key areas of asthma diagnosis, management and treatment. The new guidance, published in the Journal of Allergy and Clinical Immunology, represents the first updates to federal comprehensive asthma management and treatment guidelines in more than a decade, and focuses on tailored treatment interventions for specific age groups based on disease severity using inhaled corticosteroids, long-acting antimuscarinic agents, immunotherapy, indoor allergen mitigation, fractional exhaled nitric oxide testing, and bronchial thermoplasty. The recommendations are based on systematic reviews conducted by the Agency for Healthcare Research and Quality and input from National Asthma Education Prevention Program (NAEPP) participant organizations, medical experts, and the public.

The National Heart, Lung, and Blood Institute (NHLBI), part of NIH, coordinates the NAEPP Coordinating Committee (NAEPPCC) and the 19-member expert panel working group which developed the 2020 Focused Updates to the Asthma Management Guidelines: A Report from The National Asthma Education and Prevention Program Expert Panel Working Group.

“NHLBI’s goal is to ensure that care for all individuals living with asthma is optimal, equitable, and based on the best available evidence,” said NHLBI Director Gary H. Gibbons, M.D. “These updates to the guidelines are intended to support informed, shared decision making between patients and their providers, so that people living with this chronic condition can lead full and active lives.”

Asthma affects the airways of the lungs, causing them to narrow and interfere with breathing. According to the Centers for Disease Control and Prevention, about 25 million people in the United States have the condition, including 5.5 million children. Without appropriate treatment, asthma can significantly limit activities and result in flare-ups that may lead to hospitalization or death.

“The last national guidance on asthma care was published 13 years ago, and since then we’ve made substantial progress in understanding how to treat asthma in children and adults,” said Michelle M. Cloutier, M.D., professor emerita, UCONN School of Medicine, and chair of the NAEPPCC Expert Panel Working Group. “In addition to asthma management varying by age group and disease severity, the preferences and values that individuals with asthma place on different therapies must be considered. The new guidelines reflect some of these new approaches.”

The focused updates provide new guidance for six areas:

• Using inhaled corticosteroids when needed for recurrent wheezing or persistent asthma.
• Using long-acting antimuscarinic antagonists (LAMAs) with inhaled corticosteroids for long-term asthma management. A LAMA is a bronchodilator, a medicine that helps to keep airway muscles relaxed. 
• Using allergy shots that contain very small amounts of allergen to treat some people with allergic asthma.
• Using one or more methods to reduce exposure to indoor asthma triggers.
• Using a fractional exhaled nitric oxide test to help manage asthma or help confirm a diagnosis in some patients when the diagnosis is unclear. This test involves breathing into a tube connected to a machine that measures the amount of nitric oxide, which can increase when there is airway inflammation.
• Using bronchial thermoplasty to treat selected adults with persistent asthma. During this procedure heat is used to reduce the muscle around the airways.

Several new features aim to help health care providers and clinicians engage successfully with their patients and families to put the recommendations into practice. For example, implementation guidance sections provide expanded summaries of the recommendations to quickly assist clinicians; indicate to whom the guidance applies; show how to use it in patient care and list issues to discuss with patients and families. The stepwise treatment tables for asthma management also have been updated.

Additional resources for health care providers, including the 2020 Focused Updates to the Asthma Management Guidelines clinician’s and at-a-glance guides (with updated stepwise tables), fact sheets on the updated topic areas and FAQs, are available at www.nhlbi.nih.gov/asthmaguidelines. Along with these clinician resources, educational resources for patients and caregivers are also available through NHLBI’s Learn More Breathe Better^SM program at www.nhlbi.nih.gov/BreatheBetter.