Asthma Management Guidelines

Patient Guideline Summary

Publication Date: December 1, 2020
Last Updated: March 3, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the National Heart, Lung, and Blood Institute for asthma management guidelines. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Asthma is an allergic condition affecting the lungs.
  • There are a number of allergens that can trigger an asthma attack – pets, pests, foods, and indoor and outdoor airborne allergens.
  • Symptoms include wheezing, coughing, and shortness of breath. Other allergy symptoms such as itching, rash, runny nose, and sneezing may occur.
  • This patient summary focuses on evaluating and treating asthma in patients of all ages.

Diagnosis

Diagnosis

  • A proper diagnosis involves a history, a physical exam, a test of breathing called spirometry, and a bronchodilator responsiveness test (a test to see how sensitive the airway is to asthma treatment).
    • The history should include all suspected exposures that cause an asthma attack – respiratory tract infections, pets, pests (cockroaches, rodents), foods, and indoor allergens (tobacco smoke, mold, dust, dust mites, bedding, carpets).
    • If the diagnosis is still uncertain, another breathing test called fractional exhaled nitric oxide (FeNO) may help.
    • FeNO may also be used as part of an ongoing monitoring and management strategy to choose and adjust treatment.

Treatment

Treatment

  • When specific exposures are confirmed as causes of an asthma attack, a multicomponent allergen mitigation intervention to reduce those exposures should be instituted. For example:
    • Use impermeable pillow and mattress covers
    • Exterminate vermin
    • Limit contact with respiratory infections and suspect pets
    • Restrict known food allergens
    • Reduce indoor allergens (HEPA air purifiers and vacuum cleaners)
Medications
    • Short-acting inhaled medications – short-acting beta2-agonist (SABA), an inhaled corticosteroid (ICS)
    • Long-acting inhaled medications – long-acting beta2-agonist (LABA), long-acting muscarinic antagonist (LAMA)
    • Oral medications – corticosteroids
  • Medications are recommended depending on the severity and frequency of asthma attacks and the age of the patient.
  • Regular monitoring of symptoms and response to treatment results in the best outcome.

Immunotherapy
  • Immunotherapy added to medication involves increasing doses of an allergen by mouth (sublingual immunotherapy [SLIT]) or injection (subcutaneous immunotherapy [SCIT] – preferred) to create a tolerance so that subsequent exposures do not produce an allergic reaction.

Bronchial thermoplasty
  • Bronchial thermoplasty is not recommended for persistent asthma.

Abbreviations

  • FeNO: Fractional Exhaled Nitric Oxide
  • HEPA: High-efficiency Particulate Air
  • ICS: Inhaled Corticosteroid(s)
  • LABA: Long Acting β2 Agonist
  • LAMA: Long-acting Muscarinic Antagonist
  • LTRA: Leukotriene Receptor Antagonist
  • RTI: Respiratory Tract Infection
  • SABA: Short Acting β2 Agonist
  • SCIT: Subcutaneous Immunotherapy
  • SLIT: Sublingual Immunotherapy

Source Citation

Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC); Cloutier MM, Baptist AP, Blake KV, Brooks EG, Bryant-Stephens T, DiMango E, Dixon AE, Elward KS, Hartert T, Krishnan JA, Lemanske RF Jr, Ouellette DR, Pace WD, Schatz M, Skolnik NS, Stout JW, Teach SJ, Umscheid CA, Walsh CG. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-1270. doi: 10.1016/j.jaci.2020.10.003. Erratum in: J Allergy Clin Immunol. 2021 Apr;147(4):1528-1530. PMID: 33280709; PMCID: PMC7924476.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.