Objective:

To provide updated clinical practice guidelines for the primary care management of asthma based on emerging evidence, specifically targeting chronic asthma in patients older than 5 years.

Approach:

Key Findings:

• Single-device maintenance and reliever therapy (SMART) reduced severe asthma exacerbations by about one-third in randomized trials.
• The updated guidelines recommend ICS for all patients, regardless of symptom frequency.
• For patients aged 12 years or older with mild asthma, ICS combined with rapid-onset LABA is recommended for control and relief.

Interpretation:

The guidelines represent a significant shift towards anti-inflammatory treatment strategies in asthma management, aligning with recent evidence.

Limitations:

• The guidelines do not address acute exacerbation management, which may limit their applicability in urgent care settings.
• Biologic therapies are deferred to subspecialists, limiting primary care applicability.

Conclusion:

The 2025 VA/DoD asthma clinical practice guideline streamlines asthma management by endorsing ICS-containing therapies and step-up strategies, marking a significant shift in treatment approach.

Sources:

• Annals of Internal Medicine
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