Asthma Clinical Practice Guidelines (JSA, 2020)

Japanese Society of Allergology

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 03, 2020

Guidelines for adult asthma were published in October 2020 by the Japanese Society of Allergology (JSA).[1]


The Japanese Society of Allergology (JSA) recommends spirometry for assessing the extent of airflow limitation or airway reversibility.

The JSA recommends daily measurement of peak expiratory flow for unstable asthma and patients lacking obvious dyspnea during attack.

Although useful for diagnosing asthma, the JSA does not recommend assessing bronchial hyperresponsiveness in patients with low FEV1 (≤1 L) or low %FEV1 (≤50%) since excess airway narrowing may occur due to irritant inhalation.

Treatment of long-term adult asthma

The JSA recommends using a jet nebulizer for budesonide (BUD) inhalation suspension.

The JSA recommends adding one or more agents other than inhaled corticosteroids (ICSs), as opposed to increasing the dose of an ICS, to control asthma.

The JSA recommends long-acting β2-agonists (LABAs), leukotriene receptor antagonists (LTRAs), sustained-release theophylline, and long-acting muscarinic antagonists as add-on drugs.

The JSA recommends that anti-immunoglobulin E antibodies and other biologics as well as oral steroids be reserved for very severe and persistent asthma related to allergic reactions.

The JSA recommends inhaled β2-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches be used as needed during acute exacerbations.

Treatment during pregnancy

The JSA recommends ICSs as first-line treatment for long-term management of pregnant women with asthma.

The JSA recommends a short-acting beta-agonist (SABA) as needed for pregnant women with mild intermittent asthma.

The JSA recommends low-dose ICS; LTRA, controlled-release theophylline, and/or disodium cromoglycate (DSCG) as needed in pregnant women with mild persistent asthma.

The JSA recommends low-dose ICS and LABA or moderate-dose ICS and LABA in combination with LTRA or controlled-release theophylline as needed in pregnant women with moderate persistent asthma.

The JSA recommends high-dose ICS and LABA; oral steroids as needed for pregnant women with severe persistent asthma.

For more Clinical Practice Guidelines, go to Guidelines.

For more information, go to Asthma.


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