2020 Asthma Guidelines

They Focus On:

1. FeNO (fractional exhaled nitric oxide)

2. Indoor Allergen Mitigation

3. SCIT vs SLIT (subcutaneous vs sublingual routes)

4. Bronchial Thermoplasty

5. Inhaled Corticosteroids for recurrent wheezing

6. Long-acting antimuscarinic agents (LAMA)



Major Points:

  • These guidelines are not as wide-ranging as those developed and released in 2007.
  • The new recommendations are based on reviews of the scientific literature and the use of the GRADE methodology for assigning a level of certainty (Low, Moderate, or High) for each recommendation.
  • Of the six areas, only numbers 2, 3, 5, & 6 have practical implications for primary asthma care.
  • The full guidelines:  2020 Focused Updates to the Asthma Management Guidelines:…

Indoor Allergens

Pillow covers and mattress bags to seal in allergens are recommended if you have symptoms.  (Moderate Certainty)

Subcutaneous Allergy Shots

SCIT (Subcutaneous Immunotherapy) is recommended for adults and children (>5 yr) with mild to moderate allergic asthma. (Moderate Certainty).

Inhaled Steroids - short course

Children from ages 0-4 yr with recurrent wheezing (3 x /year), triggered by colds and URI’s should have a short course (7-10 days) of inhaled corticosteroid at the onset of a new wheezing episodes (High Certainty).

Single Maintenance Meds

In ages 4+ with moderate to severe-persistent asthma, a combination inhaler containing formoterol and corticosteroid can used as both a daily controller and as a rescue medicine. (Moderate to High Certainty).

Inhaled Steroids Daily

In ages 12 + with mild persistent asthma, inhaled corticosteroids should be used daily, either along with rescue albuterol or in a combination inhaler with albuterol. (Moderate Certainty).

Long Acting Anti-Muscarinic

In age 12 + yr with uncontrolled, persistent asthma, Long Acting Anti-Muscarinic (LAMA) medicine can be added to Inhaled Corticosteroid (ICS) for better control. (Moderate Certainty).