The 2020 Focused Updates to the NIH Asthma Management Guidelines: Key Points for Pediatricians

* Abbreviations: FeNO —: fractional exhaled nitric oxide ICS —: inhaled corticosteroid LABA —: long-acting β2-agonist LAMA —: long-acting muscarinic antagonist SABA —: short-acting β2-agonist SCIT —: subcutaneous immunotherapy SLIT —: sublingual immunotherapy SMART —: single maintenance and reliever therapy The National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group (hereinafter “panel”) of the National Heart, Lung, and Blood Institute recently published its 2020 Focused Updates to the Asthma Management Guidelines (https: //www. nhlbi. nih. gov/asthmaguidelines). 1 These are the first updates from the panel since 2007, a remarkably long interval given the advances in care of the last decade. Using the Grading Recommendations, Assessment, Development, and Evaluation platform, 2 the panel made 19 recommendations across six topic areas: intermittent inhaled corticosteroid (ICS) therapy, long-acting muscarinic antagonist (LAMA) therapy, indoor allergen-mitigation strategies, immunotherapy, fractional exhaled nitric oxide (FeNO) testing, and bronchial thermoplasty. 3 Of these, 18 are relevant to children and adolescents (Table 1). The panel made strong recommendations (to be implemented by clinicians for almost all their patients as standard of care) and conditional recommendations (intended for many individuals as part of a shared decision-making process involving the clinician, family, and patient). For pediatric clinicians, the most exciting updates are those affirming several treatment options for using ICS with long-acting β2-agonists (LABAs) and LAMAs. Those for allergen mitigation, immunotherapy, and FeNO testing provide useful clarifications but not transformative alternatives for care. Of note, the updates did not address biological therapies because at the time that a decision regarding which topics to update was made (2014), only one biologic (omalizumab) was available. View this table: TABLE 1 New Recommendations of the 2020 Focused Updates by Age Group The updates’ most highly pediatric-relevant recommendations involve three treatment options: (1) intermittent ICS dosing with as-needed short-acting β2-agonist (SABA) for quick-relief therapy, (2) single maintenance and reliever … Address correspondence to Stephen J. Teach, MD, MPH, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010. E-mail: steachatchildrensnational. org