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In December 2020, the U.S. National Asthma Education and Prevention Program (NAEPP) released its first guideline update since 2007. While this was not a complete overhaul, it addresses several issues relevant to primary care physicians and introduces as-needed use of inhaled steroids (ICS) for some patients (NEJM JW Gen Med Jan 15 2021 and JAMA 2020; 324:2301).
Key points for adolescent and adult patients (based on asthma severity) are as follows:
Step 1: As-needed short-acting β-agonists (SABAs), such as albuterol.
Step 2: For adolescent and adult patients, either daily low-dose ICS plus a SABA as needed, or as-needed ICS only when a SABA is used (i.e., no daily maintenance ICS when asymptomatic). In the U.S., no approved device contains both…