2020 NAEPP Guidelines Update and GINA 2021-Asthma Care Differences, Overlap, and Challenges

J Allergy Clin Immunol Pract. 2022 Jan;10(1S):S19-S30. doi: 10.1016/j.jaip.2021.10.032. Epub 2021 Oct 27.


The 2020 National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group (NAEPP [2020 Focused Asthma Update]) guidelines and the Global Initiative for Asthma (GINA) 2021 strategy report are compared in this Rostrum article. The methodologies of each publication are described. Subsequently, 4 different selected pharmacological recommendations are compared in the 2 documents: step 1 for children 0 to 4 years of age with viral-induced wheezing, step 2 in ages 12 years and older with the intermittent use of inhaled corticosteroid, steps 3 and 4 with single-inhaler maintenance and reliever therapy with inhaled corticosteroids-formoterol (SMART), and steps 3, 4, and 5 with add-on long-acting muscarinic antagonist therapy. Nonpharmacological recommendations are also considered and contrasted, including for exhaled nitric oxide, environmental control, immunotherapy, and bronchial thermoplasty. Similarities and differences in these 2 documents are highlighted, and recommendations are made about harmonizing the approaches where possible.

Keywords: Allergic rhinitis; Asthma; Asthma treatment; Guidelines.

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Asthmatic Agents* / therapeutic use
  • Asthma* / drug therapy
  • Child
  • Formoterol Fumarate / therapeutic use
  • Humans
  • Nebulizers and Vaporizers


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Formoterol Fumarate