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JAMA Insights
Clinical Update
February 11, 2020

Outpatient Management of Chronic Asthma in 2020

Author Affiliations
  • 1Division of Allergy and Immunology, University of Texas Medical Branch, Galveston
  • 2Division of Pulmonary Critical Care & Sleep Medicine, University of Texas Medical Branch, Galveston
JAMA. 2020;323(6):561-562. doi:10.1001/jama.2019.19986

Asthma is a chronic airway disease with recurrent symptoms of wheezing, chest tightness, dyspnea, and cough. Asthma is characterized by airway inflammation, airflow obstruction, and variable respiratory symptoms.1 The 2007 Expert Panel Report-3 Guidelines for the Diagnosis and Management of Asthma1 suggest a stepwise approach for managing asthma based on symptom severity. The stepwise approach consists of escalating or deescalating asthma therapy as needed to control symptoms and prevent adverse asthma outcomes, such as exacerbations and accelerated loss of lung function. Traditionally, chronic asthma treatments have been categorized as relievers, short-acting β2-agonists (SABAs; eg, albuterol) used to acutely relieve symptoms, and controllers, inhaled corticosteroids (ICSs) and ICSs in combination with long-acting β2-agonists (LABAs) used daily to prevent symptoms, reduce exacerbations, and improve lung function. Recently, this paradigm of asthma management has been challenged by evidence supporting novel approaches using conventional controller medications (Box).