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If you missed the webinar, we added the video below. We also included some resources on additional information discussed in the webinar.

Understanding the Latest Asthma Management Guidelines

The Asthma and Allergy Foundation of America (AAFA) hosted a webinar on May 25, 2021, on the latest asthma management guidelines from the National Heart, Lung and Blood Institute (NHLBI).

The webinar was presented by:

  • John James, MD, board-certified allergist, President of Food Allergy Consulting and Education Services, LLC, and medical specialist for AAFA
  • Kenneth Mendez, AAFA’s President and CEO
  • Lorene Alba, AE-C, AAFA's Director of Education

Watch on YouTube

In December 2020, the NHLBI published its first update to the asthma management guidelines in 13 years. The updated guidelines include 19 recommendations in six topic areas based on current studies.

The 2020 Focused Updates to the Asthma Management Guidelines recommend new ways to take asthma medicines and reduce indoor triggers that may change your treatment plan.

This webinar focused on the following topics:

  • Asthma medicines – Using long-term control medicines as needed instead of daily, and single maintenance and reliever therapy (SMART)
  • Allergy shots – An option to help control allergic asthma
  • Indoor allergen reduction – Using a multi-part strategy to reduce asthma and allergy triggers in the home

Questions and Answers

We received several great questions about the new asthma management guidelines. Here are some answers to the most common questions.

Question: Can albuterol and SYMBICORT® be used together for daily control?

Answer: Albuterol is a quick-relief medicine and is not used for daily control. SYMBICORT® is a medicine that can be taken daily for control. If you are using single maintenance and reliever therapy (SMART), you would use SYMBICORT® as your only asthma medicine for both quick-relief and control. Talk with your doctor to make sure your Asthma Action Plan lists which medicines to take and when you should take them.

Question: I am a caregiver and community health worker. Did the COVID-19 pandemic influenced new asthma management guidelines?

Answer: The 2020 Focused Updates were researched and developed before the COVID-19 pandemic. The pandemic did not influence the recommendations made in the guidelines.

Question: Does SMART pertain only to the use of SYMBICORT®?

Answer: The guidelines only mention the combination of budesonide and formoterol found in SYMBICORT®. Formoterol is the one long-acting beta agonist (LABA) that was reviewed by the workgroup and can be used as quick-relief and a controller. Formoterol (with mometasone) is also found in Dulera®. Talk with your doctor and ask which medicine is best for you.

Question: Will getting insurance companies to pay for intermittent inhaled corticosteroids (ICS) or SMART be a barrier?

Answer: Currently, controller medicines like ICS and SYMBICORT® are not approved by the Food and Drug Administration (FDA) to be used as needed (intermittent ICS) or for SMART. It is possible that insurance companies may not cover the costs until FDA approval is received. Talk with your doctor. They can work with the insurance company to help get this treatment approved.

Question: How does the new trigger reduction strategy differ from the old one?

Answer: The workgroup found there was very little data to show using one step to reduce triggers was helpful. For instance, using dust mite covers on your pillow and mattress as the only step to reduce your exposure to dust mites may not be enough. The new guidelines recommend a multi-step approach to decrease allergens. This may include using dust mite covers, using air cleaners, vacuuming weekly with a vacuum that has a HEPA filter, damp dusting, and washing your bedding once a week in hot water. The asthma & allergy friendly® Certification Program has tested several products to help make your indoor air healthier.

Question: Is SLIT (sublingual immunotherapy) used for allergic asthma?

Answer: Based on the science reviewed by the workgroup, SLIT (a tablet or drop placed under the tongue), is not recommended as an add-on treatment for allergic asthma. However, allergy shots (subcutaneous immunotherapy, or SCIT) are recommended as an add-on treatment for people with a known allergy to help manage their asthma.


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@andrew robins

Those are all legitimate concerns. Ensuring the safety of people with asthma and allergies while traveling on planes is one of AAFA’s major concerns. The ADA actually does not regulate air travel discrimination, but the Air Carrier Access Act does. AAFA advocates on these issues as a member of the Department of Transportation’s (DOT) Disabilities Advocacy Working Group.

AAFA was actively engaged with the DOT rule making last year, “Traveling by Air with Service Animals,” that was finalized on Dec. 2, 2020. The rule no longer requires airlines to accommodate emotional support animals, only trained service dogs who are "trained to do work or perform tasks for the benefit of a qualified individual with a disability." Since then, most airlines have announced bans on emotional support animals including Alaska Airlines, American Airlines, Delta Airlines, JetBlue Airlines, Southwest Airlines, and United Airlines.

We do believe preventing the abuse of service animal policies will reduce (not eliminate) the risk of allergic reactions and asthma episodes. And AAFA will continue to push the DOT for reasonable accommodations for the asthma and allergy community. We have also engaged with Congress to share the airline passenger experience of our community.


An issue that presents a significant challenge for my asthmatic wife is the inability to receive any kind of protection against being seated near pets on an airplane. With the growth in pet ownership during COVID and the increase in pet owners travelling with their pets, the situation is ever more concerning. The airlines have not put forward an approach to this issue that respects the interests of allergic passengers and point to the Americans with Disabilities Act as a basis for not attempting to protect their other disabled passengers, allergy and asthma sufferers. It appears there are solutions to this issue that protect all concerned, e.g., reasonable limits on the number of pets, including emotional support animals (arguably a tough issue), higher standards for certifying a pet as an emotional support animal, and the simplest solution, reserving a portion of the plane for people with allergies. I would be willing to participate in lobbying and communication with airlines and the Dept of Justice, which administers the ADA, if AAFA has an interest in focusing on this issue.


Last edited by Compton
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