In 2007, when the NIH published its asthma treatment guidelines, it was, in some ways, revolutionary. We had specific guidelines for how to categorize a patient’s asthma as being mild intermittent, moderate persistent, and severe persistent. And it certainly changed practice. Many of us realized that we were not treating patients with asthma aggressively enough and moved to more frequently prescribe inhaled corticosteroids and other controller medications.
In 2020, the NIH published new asthma treatment guidelines. For some reason, they do not seem to have received the same type of publicity that the 2007 guidelines did. It is therefore fortunate that Dr. Michelle Cloutier and colleagues from the University of Connecticut, Children’s National Hospital, the University of Wisconsin, and Nemours Children’s Health System have provided a primer for pediatricians. This article, entitled, “The 2020 Focused Updates to the NIH Asthma Management Guidelines: Key Points for Pediatricians,” is being early released by Pediatrics this week. (10.1542/peds.2021-050286)
You will want to read the article in its entirety, as there is much to digest here. For instance, for children 4 years and younger who have intermittent asthma, particularly for those who have wheezing with viral infections, a 7-10 day course of daily inhaled corticosteroids, with an inhaled short-acting beta-agonist as needed, is now recommended.
For children who are 4 years and older who are not well controlled on an inhaled daily corticosteroid, adding formoterol (a long-acting beta-agonist) is recommended for both daily and rescue therapy.
Despite the evidence-based revisions in these new guidelines, you will still need to check with the health insurance carriers for your patients to see what they will pay for. For instance, these guidelines are creating issues in Virginia, because Virginia Medicaid does not yet cover the specific recommended combination corticosteroid-long acting beta agonist for children younger than 12 years. Advocacy will also be needed to assure that the mismatch between these new guidelines and insurance coverage do not increase disparities in the treatment of pediatric patients with asthma.