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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.
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.
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.
No, the working group specifically suggested against the use of indoor air filtration devices for the management of asthma in these populations.
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
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A summary of the 2025 VA/DOD Clinical Practice Guideline for Asthma management in primary care, focusing on ICS-LABA therapy and comorbidity control....
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