TABLE IF.
Expert Panel recommendations
| Topic | Recommendation number* | Recommendation | Strength of recommendationy† | Certainty of evidence‡ |
|---|---|---|---|---|
| Feno | 1 | In individuals aged 5 y and older for whom the diagnosis of asthma is uncertain using history, clinical findings, clinical course, and spirometry, including bronchodilator responsiveness testing, or in whom spirometry cannot be performed, the Expert Panel conditionally recommends the addition of Feno measurement as an adjunct to the evaluation process. | Conditional | Moderate |
| 2 | In individuals aged 5 y and older with persistent allergic asthma, for whom there is uncertainty in choosing, monitoring, or adjusting anti-inflammatory therapies based on history, clinical findings, and spirometry, the Expert Panel conditionally recommends the addition of Feno measurement as part of an ongoing asthma monitoring and management strategy that includes frequent assessments. | Conditional | Low | |
| 3 | In individuals aged 5 y and older with asthma, the Expert Panel recommends against the use of Feno measurements in isolation to assess asthma control, predict future exacerbations, or assess exacerbation severity. If used, it should be as part of an ongoing monitoring and management strategy. | Strong | Low | |
| 4 | In children aged 0–4 y with recurrent wheezing, the Expert Panel recommends against Feno measurement to predict the future development of asthma. | Strong | Low | |
| Allergen mitigation | 5 | In individuals with asthma who do not have sensitization to specific indoor mitigation allergens or who do not have symptoms related to exposure to specific indoor allergens, the Expert Panel conditionally recommends against allergen mitigation interventions as part of routine asthma management. | Conditional | Low |
| 6 | In individuals with asthma who have symptoms related to exposure to identified indoor allergens, confirmed by history taking or allergy testing, the Expert Panel conditionally recommends a multicomponent allergen-specific mitigation intervention. | Conditional | Low | |
| 7 | In individuals with asthma who have sensitization or symptoms related to exposure to pests (cockroaches and rodents), the Expert Panel conditionally recommends the use of integrated pest management alone, or as part of a multicomponent allergen-specific mitigation intervention. | Conditional | Low | |
| 8 | In individuals with asthma who have sensitization or symptoms related to exposure to dust mites, the Expert Panel conditionally recommends impermeable pillow/mattress covers only as part of a multicomponent allergen mitigation intervention, not as a single-component intervention. | Conditional | Moderate | |
| ICS | 9 | In children aged 0–4 y with recurrent wheezing triggered by respiratory tract infections and no wheezing between infections, the Expert Panel conditionally recommends starting a short course of daily ICS at the onset of a respiratory tract infection with as-needed SABA for quick-relief therapy compared to as-needed SABA for quick-relief therapy only. | Conditional | High |
| 10 | In individuals aged 12 y and older with mild persistent asthma, the Expert Panel conditionally recommends either daily low-dose ICS and as-needed SABA for quick-relief therapy or as-needed ICS and SABA used concomitantly. | Conditional | Moderate | |
| 11 | In individuals aged 4 y and older with mild to moderate persistent asthma who are likely to be adherent to daily ICS treatment, the Expert Panel conditionally recommends against a short-term increase in the ICS dose for increased symptoms or decreased peak flow. | Conditional | Low | |
| 12 | In individuals aged 4 y and older with moderate to severe persistent asthma, the Expert Panel recommends ICS-formoterol in a single inhaler used as both daily controller and reliever therapy compared to either: • Higher-dose ICS as daily controller therapy and SABA for quick-relief therapy or • Same-dose ICS-LABA as daily controller therapy and SABA for quick-relief therapy. |
Strong | High (ages ≥ 12 y) Moderate (ages 4–11 y) |
|
| 13 | In individuals aged 12 y and older with moderate to severe persistent asthma, the Expert Panel conditionally recommends ICS-formoterol in a single inhaler used as both daily controller and reliever therapy compared to higher-dose ICS-LABA as daily controller therapy and SABA for quick-relief therapy. | Conditional | High | |
| LAMA | 14 | In individuals aged 12 y and older with uncontrolled persistent asthma, the Expert Panel conditionally recommends against adding LAMA to ICS compared to adding LABA to ICS. | Conditional | Moderate |
| 15 | If LABA is not used, in individuals aged 12 y and older with uncontrolled persistent asthma, the Expert Panel conditionally recommends adding LAMA to ICS controller therapy compared to continuing the same dose of ICS alone. | Conditional | Moderate | |
| 16 | In individuals aged 12 y and older with uncontrolled persistent asthma, the Expert Panel conditionally recommends adding LAMA to ICS-LABA compared to continuing the same dose of ICS-LABA. | Conditional | Moderate | |
| Immunotherapy | 17 | In individuals aged 5 y and older with mild to moderate allergic asthma, the Expert Panel conditionally recommends the use of SCIT as an adjunct treatment to standard pharmacotherapy in those individuals whose asthma is controlled at the initiation, build-up, and maintenance phases of immunotherapy. | Conditional | Moderate |
| 18 | In individuals with persistent allergic asthma, the Expert Panel conditionally recommends against the use of SLIT in asthma treatment. | Conditional | Moderate | |
| BT | 19 | In individuals aged 18 y and older with persistent asthma, the Expert Panel conditionally recommends against BT. Individuals aged 18 y and older with persistent asthma who place a low value on harms (short-term worsening symptoms and unknown long-term side effects) and a high value on potential benefits (improvement in quality of life, a small reduction in exacerbations) might consider BT. | Conditional | Low |