Guideline registry — asthma
Last verified: 2026-08-30. This registry separates current comprehensive guidance from focused/specialty documents and historical superseded sources. Official web documents were rechecked live on the verification date; every PMID was returned by live PubMed E-utilities in this audit session.
Current comprehensive guidance
| Publisher / jurisdiction |
Document |
Version |
Scope |
Verification and caveat |
| Global Initiative for Asthma |
Global Strategy for Asthma Management and Prevention |
May 2026 |
Diagnosis, chronic/acute care, ages ≥6, severe asthma, implementation |
Official GINA PDF fetched 2026-08-30; global strategy, not a regulator or payer rule |
| Global Initiative for Asthma |
2026 Summary Guide |
July 2026 |
Condensed adult/adolescent and child 6–11 pathway |
Official page fetched 2026-08-30; use full report for evidence/context |
| Global Initiative for Asthma |
Difficult-to-Treat & Severe Asthma Guide |
June 2026 |
Adolescent/adult confirmation, phenotype, biologics |
Availability confirmed on official GINA site 2026-08-30; product eligibility remains local |
| BTS / NICE / SIGN, UK |
Asthma: diagnosis, monitoring and chronic asthma management, NG245 |
November 2024; amended November 2025 |
All ages; chronic care; not acute/severe-asthma management |
Official guideline and update history fetched 2026-08-30 |
| NHLBI / NAEPP, US |
2020 Focused Updates |
December 2020; age 0–4 diagram corrected 2021 |
Six selected topics; supplements EPR-3 |
Official NHLBI page fetched 2026-08-30; not a complete revision |
| National Asthma Council Australia |
Australian Asthma Handbook v3.0 |
September 2025 |
Primary care, all ages, chronic and acute modules |
Official version/change log fetched 2026-08-30 |
| World Health Organization |
WHO PEN |
2020 |
Essential primary-care asthma/COPD interventions in resource-limited settings |
Official WHO publication fetched 2026-08-30; WHO reports new asthma guidance in development |
| US Veterans Affairs / Department of Defense |
Primary Care Management of Asthma CPG |
2025 |
Adult primary-care pathway and anti-inflammatory reliever approach |
Peer-reviewed synopsis indexed 2026 (PMID 41698207); check current official VA/DoD implementation version |
Core differences that matter at the bedside
| Topic |
GINA 2026 |
BTS/NICE/SIGN NG245 |
NAEPP 2020 focused update |
| Lowest adult/adolescent step |
Preferred as-needed low-dose ICS–formoterol |
Offer as-needed low-dose ICS/formoterol AIR from age 12 |
Did not evaluate the same mild-asthma question; daily ICS+SABA or concomitant ICS+SABA from age 12 |
| MART/SMART |
Preferred in maintenance steps using suitable ICS–formoterol |
Low-dose MART for high symptoms/severe presentation and stepwise escalation |
Preferred for moderate-to-severe persistent asthma from age 4, evidence strength age-dependent |
| Objective diagnosis |
Variable airflow; repeat/alternative test when needed |
Sequenced FeNO/eosinophil/spirometry/variability algorithm by age |
Spirometry base from EPR-3; FeNO conditional adjunct when uncertain |
| FeNO monitoring |
Contextual type-2/adherence/selected treatment support |
Diagnostic and selected monitoring role |
Do not use alone for control/attack prediction; conditional adjunct |
| LAMA |
Later add-on for uncontrolled disease |
Later add-on according to age/pathway |
Prefer LABA over LAMA with ICS when possible; conditional LAMA roles |
| Preschool viral wheeze |
Age-specific intermittent ICS option in selected recurrent wheeze |
Trial/review strategy under age 5 |
7–10-day daily ICS course at respiratory infection onset for selected recurrent wheeze |
The comparison is a routing aid, not a substitute for reading the exact population, dose, device and recommendation strength.
Current focused and specialty guidance
Diagnosis and biomarkers
| Body |
Document |
Key contribution |
Citation |
| European Respiratory Society |
Diagnosis of asthma in children aged 5–16 |
Objective pediatric testing sequence |
Gaillard EA, et al. Eur Respir J. 2021. PMID 33863747 |
| American Thoracic Society |
Interpretation of FeNO |
Contextual low/intermediate/high ranges and confounders |
Dweik RA, et al. Am J Respir Crit Care Med. 2011. PMID 21885636 |
| American Thoracic Society |
FeNO to guide asthma treatment |
Conditional guidance informed by attack outcomes |
Khatri SB, et al. Am J Respir Crit Care Med. 2021. PMID 34779751 |
| ATS |
Exercise-induced bronchoconstriction |
Objective diagnosis and pre-exercise/controller treatment |
Parsons JP, et al. Am J Respir Crit Care Med. 2013. PMID 23634861 |
Severe asthma and biologics
| Body |
Document |
Key contribution |
Citation |
| ERS / ATS |
Management of severe asthma |
Anti-IL-5, anti-IL-4Rα, tiotropium and macrolide recommendations |
Holguin F, et al. Eur Respir J. 2020. PMID 31558662 |
| American College of Chest Physicians |
Biologic management in severe adult asthma |
Comparative phenotype-driven biologic choices |
Oberle AJ, et al. Chest. 2026. PMID 41005695 |
| GINA |
Difficult-to-Treat & Severe Asthma Guide |
Practical confirmation, optimization, phenotype and response cycle |
Official 2026 guide; GINA site verified 2026-08-30 |
Acute/critical asthma
| Body |
Document |
Key contribution |
Citation |
| AARC / PALISI |
Pediatric Critical Asthma CPG |
Respiratory support and critical-care adjuncts |
White BR, et al. Respir Care. 2025. PMID 40323974 |
| BTS/NICE/SIGN |
NG245 |
Explicitly excludes acute-attack management |
Official scope verified 2026-08-30 |
| Australian Asthma Handbook |
Acute adult/adolescent modules |
2025 interim updates in primary care and emergency department |
Official change log verified 2026-08-30 |
Allergy, upper airway and prevention
| Body |
Document |
Relevance |
Citation |
| ARIA |
Next-generation allergic-rhinitis guidance |
Integrated upper/lower-airway care and shared decisions |
Bousquet J, et al. J Allergy Clin Immunol. 2020. PMID 31627910 |
| EAACI |
House-dust-mite allergen immunotherapy in allergic asthma |
Patient/product-specific immunotherapy evidence |
Agache I, et al. Allergy. 2019. PMID 31095767 |
| Clinical Practice Guideline consortium |
Immunotherapy for inhalant allergy |
Selection, safety and administration |
Seidman MD, et al. Otolaryngol Head Neck Surg. 2024. PMID 38408152 |
| EAACI |
Allergy prevention by immunotherapy |
Prevention question and evidence limits |
Halken S, et al. Pediatr Allergy Immunol. 2017. PMID 28902467 |
Pregnancy and transition
| Body |
Document |
Relevance |
Citation |
| NAEPP Pregnancy Working Group |
Pharmacologic treatment update |
Historic US pregnancy medication framework |
J Allergy Clin Immunol. 2005. PMID 15637545 |
| EAACI |
Transition of adolescents/young adults |
Structured transfer of allergy/asthma care |
Roberts G, et al. Allergy. 2020. PMID 32558994 |
| International Delphi panel |
Asthma biologics in pregnancy |
Expert consensus under sparse trial data |
Naftel J, et al. Lancet Respir Med. 2025. PMID 39216499 |
Evidence-base companion papers
| Question |
Source |
| Why GINA removed SABA-only treatment |
Reddel HK, et al. GINA Strategy 2021 rationale. Eur Respir J. 2022. PMID 34658302 |
| Primary-care translation of GINA |
Levy ML, et al. NPJ Prim Care Respir Med. 2023. PMID 36754956 |
| GINA–NAEPP divergence |
Chipps BE, et al. J Allergy Clin Immunol Pract. 2022. PMID 34718214 |
| NAEPP adult/adolescent summary |
Cloutier MM, et al. JAMA. 2020. PMID 33270095 |
| BTS/NICE/SIGN concise summary |
BTS/NICE/SIGN. Thorax. 2025. PMID 40274410 |
| Anti-inflammatory reliever implementation |
Zaeh SE, et al. J Allergy Clin Immunol Pract. 2024. PMID 38336438 |
Superseded or incomplete guidance — retain for provenance
| Document |
Status |
Why retained |
| NAEPP EPR-3 (2007) |
Partly superseded by 2020 focused update |
Still supplies US guidance for topics not updated; PMID 17983880 |
| BTS/SIGN 158 (2019) |
Replaced in relevant parts by NG245 |
Historical comparison and acute content lineage |
| NICE NG80 (2017) |
Replaced by NG245 |
Diagnostic algorithm history |
| GINA 2021/2022 peer-reviewed summaries |
Superseded by annual reports |
Documents rationale for major reliever change; PMIDs: 34658302, 36754956 |
| British guideline 2014 |
Superseded |
Historical national approach; PMID 25323740 |
| Canadian Thoracic Society 2012 update |
Superseded/older |
Historical preschool/adult guidance; PMID 22536582 |
Implementation cautions
- Check the exact edition and update date.
- Match the recommendation population, age and treatment history.
- Distinguish strong from conditional recommendations and certainty of evidence.
- Confirm exact formulation, dose, maximum daily use and inhaler license.
- Apply local formulary, emergency and referral rules.
- Preserve patient preference and shared decisions when more than one safe option exists.
- Record why a local pathway diverges from an international strategy.
Disagreements and gaps
- Reliever strategy: GINA and current UK guidance have moved toward anti-inflammatory reliever treatment at the lowest adult/adolescent steps; NAEPP 2020 did not evaluate the same evidence question and should not be read as a direct rejection.
- Diagnostic sequence: NG245 specifies an age-dependent sequence using FeNO/eosinophils and spirometry, while global and specialty documents permit more contextual sequencing. Accuracy, access and treatment already started all alter the pathway.
- FeNO: bodies agree that FeNO is contextual rather than a stand-alone asthma test, but differ in how prominently it enters diagnosis and monitoring.
- Acute care: no single current comprehensive document in this registry covers chronic, emergency and critical-care management equally; users must route to an acute-care source rather than extend NG245 beyond its scope.
- Biologic comparison: a live PubMed and ClinicalTrials.gov re-query on 2026-08-30 found that specialty guidance must still make choices with limited head-to-head randomized evidence, heterogeneous eligibility and local payer rules.
- Pregnancy: biologic recommendations rest on registries, observational evidence and consensus because pregnant people are routinely excluded from pivotal trials.
- Low-resource implementation: WHO PEN addresses essential primary care, but contemporary anti-inflammatory reliever availability, spirometry, specialist biomarkers and biologics remain unevenly represented in global implementation evidence.
Watch list / update triggers
- Annual GINA report and severe-asthma guide release.
- NICE/BTS/SIGN surveillance or product-license amendment.
- New NAEPP comprehensive update rather than focused supplement.
- WHO release of the asthma/COPD primary-care guideline currently in development.
- Regulatory approval of a new reliever formulation, biologic, pediatric age or pregnancy indication.
- Head-to-head biologic or withdrawal/remission evidence sufficient to change specialty guidance.
Related wiki page