Managing Asthma in Adolescents and Adults

Abstract

Asthma is a major public health problem worldwide and is associated with excess morbidity, mortality, and economic costs associated with lost productivity.¹ Guidelines for asthma were first released in the United States in 1991 by the National Heart, Lung, and Blood Institute and were most recently updated in 2007.² An expert panel was convened in 2018 to update the asthma guidelines. In 2020, this expert panel published a selected topics update³ to the 2007 National Asthma Education and Prevention Program Expert Panel Report 3 (EPR-3) that was based on a formal needs assessment that had been conducted in 2014.⁴ The 6 topics chosen for updating included intermittent inhaled corticosteroids (ICSs); add-on long-acting muscarinic antagonists (LAMAs); fractional exhaled nitric oxide (FeNO) measurement as a biomarker for asthma diagnosis, management and monitoring response to therapy; indoor allergen mitigation strategies; safety and efficacy of subcutaneous and sublingual immunotherapy; and bronchial thermoplasty. Eleven additional topics were identified⁴ but not selected for the update because the National Heart, Lung, and Blood Advisory Council concluded there was insufficient new information at the time to support an update; asthma biologic therapy was considered an emerging therapeutic option at that time but was not selected as a priority topic.