VA DOD Updates Asthma Framework

The 2025 US Department of Veterans Affairs and US Department of Defense asthma guideline introduces 21 evidence-based recommendations for primary care, redefining stepwise treatment, comorbidity management, and reliever strategy.

By
Kathryn Wighton
February 17, 2026
4 min

Conexiant

At a Glance

Category	Detail
Condition	Asthma
Key Mechanisms	Shift from symptom-driven reliever therapy to anti-inflammatory strategies, emphasizing inhaled corticosteroids (ICS) and rapid-onset long-acting beta-agonists (LABA).
Target Population	Patients older than 5 years with chronic asthma.
Care Setting	Primary care

Key Highlights

Single-device maintenance and reliever therapy (SMART) reduces severe asthma exacerbations by about one-third.
Updated guidelines recommend ICS-containing reliever strategies over SABA-only therapy.
Emphasis on managing comorbidities like obesity and gastroesophageal reflux disease to improve asthma control.
Step-down therapy is appropriate after stable control for at least 3 months, but ICS should not be discontinued.
Routine spirometry for stable asthma monitoring is not recommended.

Guideline-Based Recommendations

Diagnosis

Focus on chronic asthma management in primary care settings.

Management

Use ICS for asthma control in all patients, regardless of symptom frequency.
Consider ICS combined with rapid-onset LABA for patients aged 12 years or older.

Monitoring & Follow-up

Avoid routine spirometry for monitoring stable asthma.

Risks

Increased asthma-related morbidity and mortality linked to insufficient ICS use.

Patient & Prescribing Data

Adults with asthma, particularly those with comorbid conditions.

Weight loss and treatment of gastroesophageal reflux disease can improve asthma control.

Clinical Best Practices

Develop a written asthma action plan to enhance control and quality of life.
Avoid routine use of indoor air filtration devices due to limited evidence of benefit.