Dr Neil Skolnik summarizes the most significant changes to asthma management guidelines.
I’m dr neil skolnick today we’re going to discuss the 2020 update to the nih asthma guidelines for individuals 12 years of age and older i had the privilege to serve as one of the members of the expert group that developed the guidelines which represent the first update to these guidelines since 2007 and there are some very important changes for us to be aware
Of i’m going to emphasize the preferred approach in the guidelines recognizing that there are alternatives given that go beyond the scope of our discussion and i’ll mention where the world health organization gina asthma guidelines differ from the nih guideline let’s start with mild intermittent disease or step one therapy here there’s no change from the 2007
Guidelines short acting beta agonists or albuterol is used as needed of note here though the gina guidelines recommend using even for intermittent disease a combination of low-dose inhaled steroids whenever a beta agonist is used let’s move on now to mild persistent disease or step 2 therapy in 2007 this was straightforward and inhaled steroid alone in the current
Guidelines and this is a big change there’s a choice of preferred therapy either an inhaled steroid alone using albuterol as rescue therapy or a protocol where we use both an inhaled steroid and albuterol together but only use it when symptoms occur the gina guidelines give as needed ics for motorol in a combination inhaler as a similar option here the idea here
Is that patients benefit from receiving inhaled steroids when they’re experiencing symptoms in order to decrease inflammation and the likelihood of them going on to have a full exacerbation the advantage of an ics alone is that there are less breakthrough symptoms the advantage of as needed combination ics beta agonist therapy is that you get the inhaled steroid
And the beta agonist only when you need it thereby having a lower total dose of inhaled steroid over time but you have no more exacerbations than you do with an inhaled steroid daily alone for patients needing step 3 therapy that would be moderate persistent disease the 2007 guidelines recommended stepping up from a daily inhaled steroid to low-dose combination
Ics lab therapy continuing albuterol as needed for breakthrough symptoms the 20 20 guidelines and this is another big change recommend using daily combination low-dose ics for motorol along with and pay careful attention here low-dose ics for motorola as reliever therapy as well thereby giving more inhaled steroid whenever there are symptoms the acronym smart
Therapy which stands for single maintenance and reliever therapy has been used for this the gina guidelines recommend that in step three the use of any inhaled steroid lava combination therapy is appropriate and this is an alternative in the nih guidelines for patients requiring step four therapy that is those with moderate to severe persistent disease the 2020
Guidelines recommend bumping up to daily and prn medium dose ics for motorol with an alternative choice of medium dose ics lava combination therapy or even an ics with a llama all using albuterol for breakthrough if an individual is not controlled on daily medium dose ics lava therapy then we now have as an option adding a llama long-acting muscarinic antagonist
For step 5 care remember llamas had not been studied for asthma back in 2007 they now have been they work and they can be a real advantage for some patients remember for patients with severe asthma particularly those with frequent exacerbations not control with standard therapy we can use high dose ics lava and there is also now a whole new class of biologic agents
The monoclonal antibodies that are available usually with specialty consultation these are some big important changes i’m neil skulnick and this is medscape you
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Big, Important Changes in Asthma Management Guidelines By Medscape
