Earlier this year, the National Institute of Health, National Asthma Education Prevention Panel (NAEPP) Working Group released an update to guidelines that healthcare providers use to diagnose and treat asthma. Based on research from the work group, the 2020 Focused Updates to Asthma Clinical Guidelines targets six areas of the guidelines. The six areas include:
- Using inhaled corticosteroids when needed
- Using long-acting antimuscarinic agents (LAMAs) with inhaled corticosteroids for daily control of asthma
- Using one or more methods to avoid indoor asthma triggers
- Using allergy shots to treat people with allergic asthma
- Using a diagnostic test called, fractional exhaled nitric oxide (FeNO), to help manage or confirm an asthma diagnosis
- Using bronchial thermoplasty to treat some adults with difficult to treat asthma.
Using inhaled corticosteroids when needed for asthma symptoms.
If you have asthma, depending on the severity of your disease, you may have been prescribed a daily inhaled corticosteroid (ICS) to prevent inflammation (or swelling) inside the airways. The 2020 focused updates recommend that some people with asthma use an ICS with their quick-relief medicine, known as a short-acting bronchodilator or albuterol sulfate. The period of time and the frequency that these medicines are used together varies by age and the severity of your asthma. For example, children with asthma that wheeze when they get a respiratory infection, like a cold or bronchitis, should use a short course (7 –10 days) of an ICS, and quick-relief medicine as needed for asthma symptoms. For children and adults with moderate to severe asthma that take a low- or medium-dose ICS, it is recommended to use a single inhaler that has ICS plus formoterol daily and as needed for symptoms. This is called SMART or single maintenance and reliever therapy. SMART may be especially helpful for people that have had severe asthma episodes in the previous year.
Talk to your healthcare provider to see if these new recommendations are right for you or your child.
Using long-acting antimuscarinic agents (LAMAs) with inhaled corticosteroids (ICS) for daily control of asthma.
If your asthma is not well-controlled with an ICS alone, your doctor may add another long-term controller medicine called a long-acting bronchodilator, such as a long-acting beta2-agonist (LABA) or a long-acting muscarinic antagonists (LAMA). These medicines are also used to control swelling inside the airways and, by adding to your daily ICS, may help to control your asthma better. Talk to your healthcare provider to see if adding LABA, and LAMA, or both will help you take control and be more active.
Using one or more methods to avoid indoor asthma triggers.
Most people with asthma have allergic asthma, which means they are sensitive to allergens, such as animals, pets, house dust mites, mold, or pests (e.g., cockroaches, mice, or rats). The 2020 updates recommend that people with sensitivity to indoor allergens use multiple strategies to reduce their exposure to the trigger. For example, to prevent asthma symptoms in people that are allergic to dust mites, using pillow and mattress covers plus using a HEPA filtration system in vacuum cleaners, is a much more effective intervention than one strategy on its own. In addition, to prevent exposure to common pests in the home, using integrated pest management (IPM) techniques to control pests is recommended. All of these recommendations may not be appropriate for you, so talk to your healthcare provider to identify your asthma triggers and together make a plan to prevent or reduce exposure.
Using allergy shots to treat people with allergic asthma.
For people with allergic asthma, the 2020 updates recommend using allergy shots (also called immunotherapy) to treat your overall asthma. Immunotherapy exposes you to small amounts of the allergen over time and can help control symptoms. At this time, studies have shown that people with allergic asthma should not use sublingual (placing drops or tablets under the tongue) treatment. Talk to your healthcare provider about your asthma triggers and see if allergy testing is right for you. If you have allergic asthma and symptoms that are not well-controlled, adding an allergist to your treatment team might be an option for you.
Using a diagnostic test called, fractional exhaled nitric oxide (FeNO), to help manage or confirm an asthma diagnosis.
FeNO is a tool to help healthcare providers diagnosis and monitor airway inflammation. The test requires you to breathe into a device that measures the amount of nitric oxide that you exhale. It is recommended for people ages 5 and older to help diagnose asthma for the first time or to monitor airway inflammation to find the best treatment options to control asthma. To assess asthma control, it is recommended to use FeNO testing along with other tools, like getting a full medical history, clinical findings, and spirometry. FeNO is not recommended for children ages 4 or younger to predict the development of asthma. Not all healthcare providers use FeNO because it requires equipment, and special training to interpret the results.
Using bronchial thermoplasty to treat some adults with difficult to treat asthma.
Bronchial thermoplasty (BT) is a procedure that uses heat to reduce muscle tissue around the airways that tighten during asthma episodes and makes it hard to breathe. It is not recommended for adults (18+) with uncontrolled, moderate to severe persistent asthma because the benefits are small, the risks are moderate, and the long-term outcomes are uncertain. If you are struggling with asthma symptoms and your asthma is not well-controlled with asthma medicines, BT may be a treatment option to consider. Discuss this option with your healthcare provider and see if the risks outweigh the benefits for you.
If your asthma is well-controlled on your current therapy, there may be no need to make any changes. Asthma is well-controlled if you:
- Need your quick-relief inhaler less than three times per week.
- Do not wake up with asthma during the night.
- Do not have interruptions to your daily activities due to your asthma (including exercise).
It is important to continue to monitor your asthma and communicate with your healthcare team. If you are using your quick-relief medication frequently or not feeling well controlled, speak to your healthcare providers about other treatment options. Also, it is important to remember that medication is just part of the solution. There are changes that can be made in your home environment that can improve your breathing as well. Work with your healthcare team and design a treatment plan that works for you so you can be active and healthy.
Blog last updated: May 26, 2021