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
Clinical Scorecard: VA DOD Updates Asthma Framework
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. Related Resources & Content
