The U.S. Department of Veterans Affairs (VA) and the Department of Defense (DOD) recently released the asthma management guidelines 2025 update. This synopsis highlights critical changes for primary care providers who manage veterans and military personnel. Notably, the guideline reflects a significant shift toward streamlined pharmacological interventions and evidence-based adjunct care. Providers must now focus on reducing airway inflammation through earlier and more consistent use of corticosteroids.

Furthermore, the working group strongly recommends inhaled corticosteroids (ICS) for all patients requiring maintenance therapy. Specifically, the guidelines suggest a combination of ICS and a rapid-onset long-acting β-agonist (LABA) as both a reliever and a controller. Consequently, this approach, often called SMART therapy, simplifies treatment regimens and improves patient adherence. If patients remain symptomatic, clinicians should consider step-up therapy. This process involves increasing the ICS dose or adding long-acting anticholinergic agents to the existing regimen.

Clinical Implementation of Asthma Management Guidelines 2025

In addition to pharmacological adjustments, the 2025 update emphasizes the management of concurrent conditions. Clinicians should proactively address symptomatic gastroesophageal reflux disease (GERD) and obesity. Both conditions frequently exacerbate asthma symptoms and hinder long-term control. However, the panel suggested against the routine use of indoor air filtration devices for asthma management. Finally, the guidelines provide clear decision points for referring complex cases to subspecialists when primary care interventions do not yield expected results.

Frequently Asked Questions

What is the preferred rescue therapy in the 2025 update?

The guidelines suggest using a combination of an inhaled corticosteroid (ICS) and a rapid-onset long-acting β-agonist (LABA) as both a reliever and a controller agent.

Does the new guideline recommend indoor air filters?

No, the working group specifically suggested against the use of indoor air filtration devices for the management of asthma in these populations.

How should primary care providers handle uncontrolled asthma?

Clinicians should consider step-up therapy by increasing the ICS dosage or adding long-acting anticholinergics, while also managing comorbidities like obesity and GERD.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a standard of care. Clinicians should use their professional judgment and consider individual patient needs. Refer to the latest local and national guidelines for clinical practice.

References

1. Sharafkhaneh A et al. A Synopsis of the 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Primary Care Management of Asthma. Ann Intern Med. 2026 Feb 17. doi: 10.7326/ANNALS-25-03080. PMID: 41698207.


2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Available from: ginasthma.org.


3. U.S. Department of Veterans Affairs. VA/DOD Clinical Practice Guideline for the Management of Asthma. 2025.