Asthma Management Guidelines 2020 Focused Update: What’s In It For You?

Dec 14, 2020 | Action Plan, Control Your Asthma!, PEF, symptoms

* The National Institutes of Health, National Heart, Lung, and Blood Institute coordinated this update

* Recommendations were published on December 1, 2020.

* It Focuses on six areas:

….Fractional Exhaled Nitric Oxide Testing

….Indoor Allergen Mitigation

….Intermittent Inhaled Corticosteroids

….Immunotherapy in the Treatment of Allergic Asthma

….Bronchial Thermoplasty

* Only four of these six areas have immediate implications for asthma disease management in primary care.

* I’ll review the recommendations briefly here.

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.


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

Allergy Shots: SCIT (Subcutaneous Immunotherapy) is recommended for adults and children (>5 yr) with mild to moderate allergic asthma as long as they have lab or skin testing data to support the allergy. (Moderate Certainty).

Wheezing in Kids: 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 episode. (High Certainty).

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

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

This approach to wheezing is referred to as Single Maintenance And Reliever Therapy (SMART).  

UPDATE (3/17/22): Today, the FDA approved a generic inhaler containing formeterol and budesonide (the components of Symbicort)!  This will put SMART inhaler use within the price reach of asthma sufferers 5 years of age and older.

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

I have devoted a full page to discuss how these recommendations will affect my asthma care plans in further detail.

If you have questions about asthma management or want to update your asthma action plan and medication prescriptions, grab an appointment and let’s talk!

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* A spacer is needed to hold your asthma medicine in a cloud until you can pull it into your lungs with a deep breath.

* If you don’t use a spacer with your asthma medicine, it ends up on tongue and on the walls of your throat where it can’t help your asthma and usually causes a yeast infection.

* Spacers should be used with all of your asthma medicine that comes in a metered dose inhaler (MDI).

* Medicine administered by a dry powder inhaler does not require a spacer since the design of the inhaler stirs and suspends the dry powder particles so they can be inhaled deeply.