Primary Care Management of Asthma

Publication Date: January 1, 2019
Last Updated: March 14, 2022

Recommendations

Diagnosis and Assessment

We suggest spirometry if there is a need to confirm a clinical diagnosis of asthma. (Weak for)
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In primary care, we suggest against whole-body plethysmography as part of the diagnostic evaluation of asthma. (Weak against)
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There is insufficient evidence to recommend for or against the routine use of bronchodilator response testing to exclude the initial diagnosis of asthma in the absence of airway obstruction. ()
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If bronchoprovocation testing is considered, we suggest methacholine challenge testing. (Weak for)
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We recommend against offering computed tomography scan to diagnose asthma in patients with persistent airflow obstruction post-bronchodilator. (Strong against)
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In adults and children with asthma, we suggest identifying known risk factors of asthma-related outcomes including overweight/obesity, atopy, secondhand smoke exposure in children, and history of lower respiratory infection. (Weak for)
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In adults with asthma, we suggest identifying known risk factors of asthma-related outcomes including depression, current smokers, and Operation Iraqi Freedom/Operation Enduring Freedom combat deployment. (Weak for)
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Treatment and Management

We suggest offering a written asthma action plan to improve asthma-related quality of life. (Weak for)
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We suggest offering asthma education. (Weak for)
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There is insufficient evidence to recommend one particular asthma education program or education component(s) over others. ()
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There is insufficient evidence to recommend for or against patient-oriented technologies (e.g., mobile apps, web based, or telemedicine) as a means to reduce the number or severity of asthma-related exacerbations. ()
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For patients with persistent asthma, we recommend inhaled corticosteroids as initial controller medication. (Strong for)
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Among patients with moderate-to-severe persistent asthma and significant symptom burden, we suggest offering a combination of inhaled corticosteroid and long-acting beta agonist as initial controller treatment. (Weak for)
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For patients with asthma not controlled by inhaled corticosteroids alone, we suggest adding long-acting beta agonists as a step-up treatment over increasing inhaled corticosteroids alone or adding long-acting muscarinic antagonists or leukotriene receptor antagonists. (Weak for)
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In patients with controlled asthma on a stable medication regimen, we suggest either stepping down (not discontinuing) inhaled corticosteroids dose or discontinuing long-acting beta agonists. (Weak for)
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We suggest short-acting beta agonists or leukotriene receptor antagonists for prevention of exercise-induced bronchospasm. (Weak for)
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We suggest a multidisciplinary treatment approach to improve asthma-related quality of life, asthma control, and treatment adherence. (Weak for)
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We suggest patients with asthma participate in regular exercise to improve quality of life and asthma control. (Weak for)
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We suggest offering cognitive behavioral therapy as a means of improving asthma-related quality of life and self-reported asthma control for adult patients with persistent asthma. (Weak for)
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We suggest against utilizing spirometry for routine monitoring of patients with stable asthma. (Weak against)
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There is insufficient evidence to recommend for or against routine use of fractional exhaled nitric oxide in monitoring patients in primary care settings to improve asthma-related clinical outcomes. ()
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We suggest leveraging electronic health record capabilities such as trackers and reminders in the care of patients with asthma. (Weak for)
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a If not otherwise specified, the recommendation applies to the target population for this CPG, which includes adults and children four years or older.

Recommendation Grading

Overview

Title

Primary Care Management of Asthma

Authoring Organization

Endorsing Organizations

Publication Month/Year

January 1, 2019

Last Updated Month/Year

January 29, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Childcare center, Outpatient

Intended Users

Physician, paramedic emt, nurse, nurse practitioner, physician assistant

Scope

Assessment and screening, Diagnosis, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D001249 - Asthma

Keywords

asthma, Bronchoprovocation testing, asthma education

Methodology

Number of Source Documents
155
Literature Search Start Date
January 1, 2008
Literature Search End Date
July 24, 2018