Updated VA/DOD asthma guidelines prioritize inhaled steroids while rejecting air filtration devices.
An updated joint clinical guideline from the Department of Veterans Affairs (VA) and Department of Defense (DOD) recommends a streamlined, more effective approach to asthma care for veterans and service members, most notably endorsing inhaled corticosteroids (ICS) as the cornerstone of treatment and combining them with a rapid‑onset long‑acting beta‑agonist to simplify daily management. A synopsis of this updated guideline is published in Annals of Internal Medicine.
To update its 2019 recommendations, the VA and DOD assembled a multidisciplinary work group in 2024 to evaluate the latest evidence on asthma care. Using a systematic review of research published between July 2018 and May 2024, the group developed 12 key clinical questions and applied the GRADE system to rate evidence and shape 21 final recommendations.
The updated guideline concludes that:
- inhaled corticosteroids, either alone or paired with a rapid‑onset long‑acting beta‑agonist, should remain the primary treatment, with dose adjustments or added long‑acting anticholinergic medications used to step up care.
- It also finds that addressing conditions like GERD and obesity can improve asthma control,
- It suggests against the use of indoor air filtration devices.
- The guideline further provides clear points for when primary care providers should refer patients to specialists.
