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NHLBI Updates Guidance for Asthma Diagnosis, Management, and Treatment


The NHLBI recently updated recommendations in 6 key areas of asthma diagnosis, management, and treatment, marking the first update of the guidance in over 10 years.



The National Heart, Lung, and Blood Institute (NHLBI) recently released new recommendations in 6 key areas of asthma diagnosis, management, and treatment in adolescents and adults, the first updates to federal comprehensive asthma guidelines in over 10 years.

Published in the December issue of the Journal of Allergy and Clinical Immunology, the 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group was 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 NHLBI coordinated the NAEPP Coordinating Committee (NAEPPCC) and the 19-member expert panel working group that developed the updated guidance.

“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, MD, professor emerita, University of Connecticut School of Medicine, chair, NAEPPCC Expert Panel Working Group, in a NHLBI press release. “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 provided new guidance in 6 key areas:

  • Using inhaled corticosteroids (ICSs) when needed for recurrent wheezing or persistent asthma.
  • Using long-acting antimuscarinic antagonists with ICSs for long-term asthma management.
  • Using allergy shots that contain very small amounts of allergen for the treatment of allergic asthma.
  • Methods to decrease exposure to indoor asthma triggers.
  • Using a fractional exhaled nitric oxide test to help manage asthma or help confirm a diagnosis when unclear.
  • Using bronchial thermoplasty to treat selected adults with persistent asthma.

Another significant change was that for patients aged ≥4 years with moderate-to-severe persistent asthma, the preferred treatment is formoterol in combination with an ICS in a single inhaler—or, single maintenance and reliever therapy (SMART)—for both daily and as-needed therapy.

“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, MD, in the same NHLBI press release. “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.”

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