Asthma Treatment Guidelines

Several groups publish guidelines to help doctors monitor and treat asthma. Experts review clinical articles and make suggestions based on evidence. Two examples of asthma treatment guidelines include:

  • The Global Initiative for Asthma (GINA) report
  • The National Asthma Education and Prevention Program (NAEPP) report

Experts then keep these guidelines updated with new clinical evidence. The guidelines lead to good control of asthma symptoms. However, many doctors may not always follow them.

What are the Global Initiative for Asthma guidelines?

The National Institutes of Health (NIH) and World Health Organization (WHO) started GINA in 1993. GINA aims to increase awareness of asthma and improve asthma management. This includes publishing a yearly report. It is called the Global Strategy for Asthma Management and Prevention.1

GINA first published the report in 2002 and has updated it every year since. The most recent update came in 2021. The process for updating and revising the report includes:1

  • Searching recent publications for new management techniques
  • Reviewing articles for relevance and quality
  • Discussing how to include new articles in the report

The report has 2 sections. Section 1 focuses on adults and children over 6 years old. Section 2 focuses on children under 5 years old. Each section contains chapters on:1

  • Definitions and descriptions of asthma
  • Making the initial diagnosis
  • Assessing asthma control
  • Goals of asthma treatment
  • Medicine and treatment tracks
  • Guidelines for treating specific populations

The key changes in the 2021 update of the GINA report include:1

  • Guidance about asthma and COVID-19
  • Updated definitions of mild and severe asthma
  • Treatment guidelines based on the choice of quick-relief medicines
  • Updates on the use of long-acting muscarinic antagonists (LAMAs)
  • Vitamin D supplements for pregnant women with asthma

GINA plans to address many other topics in future reports. This includes guidelines for immunotherapy and management of asthma in young children.1

What are the National Asthma Education and Prevention Program guidelines?

The NAEPP started in 1989. It raises awareness about asthma and improves diagnosis and management. The NIH administers the NAEPP. The NAEPP develops asthma guidelines, helps put guidelines into practice, and manages other activities.2

The NAEPP first published guidelines in 1991 and revised them in 2002 and 2007. It is called the Guidelines for the Diagnosis and Management of Asthma. The guidelines have 5 sections:3

  • Methods used to make the guidelines
  • Definitions and descriptions of asthma
  • Parts of asthma management
  • Managing asthma long-term
  • Managing asthma episodes

The most recent update to the guidelines issued in 2020. The update focused on 6 areas:2

  • Using exhaled nitric oxide to diagnose and monitor asthma
  • Reducing exposure to indoor allergens
  • Intermittent inhaled corticosteroids
  • Prescribing LAMAs along with inhaled corticosteroids
  • Immunotherapy
  • Bronchial thermoplasty

How do doctors use asthma treatment guidelines?

Asthma treatment guidelines help standardize how to diagnose, monitor and treat asthma. This makes it easy for doctors to decide which tests to perform or which drugs to prescribe. It also explains special situations that may change management plans.4

Following these guidelines leads to better control of asthma symptoms. Unfortunately, many doctors do not always follow the guidelines. For example, doctors often do not:5,6

  • Ask enough questions about how often you have symptoms
  • Spend enough time figuring out your triggers
  • Use asthma action plans enough
  • Use spirometry enough

It is important to find a doctor who talks to you about your asthma symptoms and works with you to develop a treatment plan that keeps your asthma well-controlled. If you have severe or difficult-to-control symptoms, you should be referred to a lung or allergy specialist.

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Written by: Matt Zajac | Last reviewed: October 2021