Pulmonology · General Practice · 2 h ago
ATS guideline supports ICS-containing relievers across asthma treatment steps
An American Thoracic Society clinical practice guideline used systematic reviews and GRADE assessments to evaluate inhaled corticosteroid (ICS)-containing reliever therapy in adolescents and adults across asthma treatment steps 1–5. It recommends ICS-containing relievers over SABA-only treatment at steps 1–2 and favors ICS-formoterol maintenance-and-reliever therapy at steps 3–5.
- Strongly favors ICS-containing relievers over SABA alone at steps 1–2.
- Strongly favors ICS-formoterol MART at steps 3–5.
- ICS-plus-SABA reliever is conditionally favored for some step 3–5 patients.
An American Thoracic Society guideline panel assessed six PICO-framed questions on ICS-containing reliever therapy for adolescents and adults across National Asthma Education and Prevention Program treatment steps 1–5. The panel used systematic literature reviews and GRADE assessments to inform its recommendations. The guideline addresses ICS-formoterol and ICS plus a short-acting beta2-agonist (SABA), delivered in combination or separate inhalers.
For steps 1–2, the panel strongly recommends as-needed-only ICS-SABA or ICS-formoterol over SABA-only therapy, and conditionally recommends these options over scheduled ICS with as-needed SABA. For steps 3–5, it strongly recommends maintenance-and-reliever therapy (MART) with ICS-formoterol over scheduled ICS-LABA plus as-needed SABA. For patients at steps 3–5 already using scheduled maintenance ICS-LABA, it conditionally recommends an ICS-plus-SABA reliever over a SABA reliever.
The panel prioritized preventing severe exacerbations while considering SABA-only treatment risks and exposure to inhaled and systemic corticosteroids. The recommendations are based on evidence reviews and GRADE appraisal; the supplied abstract does not provide effect estimates or detailed evidence-certainty ratings for individual recommendations.
In practice
For adolescents and adults with asthma, the ATS guideline supports using an ICS-containing reliever rather than SABA alone at NAEPP steps 1–2, and strongly favors ICS-formoterol maintenance-and-reliever therapy over scheduled ICS-LABA plus SABA at steps 3–5. For patients at steps 3–5 already taking scheduled ICS-LABA, an ICS-plus-SABA reliever is conditionally favored over SABA alone. These are guideline recommendations informed by systematic reviews and GRADE; the supplied abstract gives no effect estimates or detailed certainty ratings, so it does not quantify expected benefits or harms.
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American Journal of Respiratory and Critical Care Medicine: As-needed inhaled corticosteroids in asthma: an Official American Thoracic Society clinical practice guideline ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.