Adult asthma in general practice

Overview

Asthma is a chronic inflammatory disorder of the airways in which inflammation causes recurrent episodes of wheeze, breathlessness, chest tightness and cough, together with variable expiratory airflow limitation. The inflammation is present between symptoms, even when the patient feels well; the symptoms are only its surface expression.^[38]

Asthma affects an estimated 260 million people worldwide and accounts for substantial morbidity, mortality and cost. It is heterogeneous: patients differ in age of onset, triggers, pattern of inflammation, natural history and response to treatment. Most adults with asthma are managed in general practice, which makes accurate diagnosis and correct first-line prescribing the highest-yield interventions in the whole disease.^[9]

Four modifiable risk factors account for nearly 30% of the global disease burden: high body mass index, occupational exposures, traffic-related air pollution (NO₂) and smoking. Smoking cessation, weight management and workplace assessment therefore modify the disease itself.^[9]

References41ShowHide

1. [1]British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) BTS/NICE/SIGN joint guideline on asthma: diagnosis, monitoring and chronic asthma management (November 2024) - summary of recommendations Thorax, 2025.PMID 40274410
2. [2]Levy ML, Bacharier LB, Bateman E, et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update NPJ primary care respiratory medicine, 2023.PMID 36754956
3. [3]Reddel HK, Bacharier LB, Bateman ED, et al. Global Initiative for Asthma Strategy 2021. Executive Summary and Rationale for Key Changes Archivos de bronconeumologia, 2022.PMID 35245179
4. [4]Miyata J, Fukunaga K Contemporary Concise Review 2025: Asthma Respirology (Carlton, Vic.), 2026.PMID 42386508
5. [5]Simpson AJ, Drake S, Healy L, et al. Asthma diagnosis: a comparison of established diagnostic guidelines in adults with respiratory symptoms EClinicalMedicine, 2024.PMID 39296585
6. [6]Ducharme FM, Chan R Oscillometry in the diagnosis, assessment, and monitoring of asthma in children and adults Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2025.PMID 39603340
7. [7]Marain NF, Claus R, Colemont M, et al. Exploring the role of cold air in airway hyperresponsiveness and asthma diagnostic testing: a systematic review and meta-analysis European respiratory review : an official journal of the European Respiratory Society, 2026.PMID 42128487
8. [8]Reddel HK, Ampon MR, Poulos LM, et al. Worsening Asthma Outcomes in Australian Adults: A Comparison of Stratified Sample Surveys in 2012 and 2021 The Medical journal of Australia, 2026.PMID 42338170
9. [9]Koppelman GH, Pino-Yanes M, Melén E, et al. Genetic and environmental risk factors for asthma: towards prevention The Lancet. Respiratory medicine, 2025.PMID 41038211
10. [10]Xie C, Wei Y, Su C, et al. Mechanisms and therapeutic strategies of asthma: from bench to bedside Signal transduction and targeted therapy, 2026.PMID 42572038
11. [11]Barkas GI, Kotsiou OS, Gouta E, et al. T2-Low Asthma: Mechanistic Pathways, Biomarkers, and Emerging Therapeutic Strategies The Journal of asthma : official journal of the Association for the Care of Asthma, 2026.PMID 42619443
12. [12]Jiménez-Gómez M, Almonacid-Sánchez C, Blanco-Aparicio M, et al. Eosinophilic Inflammation in Severe Asthma: Pathophysiology, Clinical Identification, and Therapeutic Implications The Journal of asthma : official journal of the Association for the Care of Asthma, 2026.PMID 42613890
13. [13]Beasley R, Holliday M, Reddel HK, et al. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma The New England journal of medicine, 2019.PMID 31112386
14. [14]Gauthier M, Wenzel SE As-needed β agonist-inhaled corticosteroid in mild asthma Lancet (London, England), 2019.PMID 31451208
15. [15]Lazarus SC, Krishnan JA, King TS, et al. Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil Level The New England journal of medicine, 2019.PMID 31112384
16. [16]Noble JH, Bean O, Perry M, et al. Budesonide-formoterol versus terbutaline reliever in adults with asthma using maintenance inhaled corticosteroids in New Zealand (INFORM ASTHMA): an open-label, parallel-group, randomised, controlled, phase 4 trial The Lancet. Respiratory medicine, 2026.PMID 41520676
17. [17]LaForce C, Albers F, Danilewicz A, et al. As-Needed Albuterol-Budesonide in Mild Asthma The New England journal of medicine, 2025.PMID 40388330
18. [18]Bruce P, Houghton C, Hatter L, et al. An anti-inflammatory reliever algorithm approach to asthma management in adults: an open-label, single-arm trial EClinicalMedicine, 2025.PMID 41357339
19. [19]Rovsing AH, Savran O, Ulrik CS Magnesium sulfate treatment for acute severe asthma in adults-a systematic review and meta-analysis Frontiers in allergy, 2023.PMID 37577333
20. [20]Kew KM, Flemyng E, Quon BS, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children The Cochrane database of systematic reviews, 2022.PMID 36161875
21. [21]Gatheral TL, Rushton A, Evans DJ, et al. Personalised asthma action plans for adults with asthma The Cochrane database of systematic reviews, 2017.PMID 28394084
22. [22]Villa-Roel C, Voaklander B, Ospina MB, et al. Effectiveness of written action plans for acute asthma: A systematic review The Journal of asthma : official journal of the Association for the Care of Asthma, 2018.PMID 28453378
23. [23]Blakey J, Chung LP, McDonald VM, et al. Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand Respirology (Carlton, Vic.), 2021.PMID 34587348
24. [24]Li J, Ernst P, Suissa S Transient Oral Corticosteroid Use and Acute Upper Gastrointestinal Bleeding in Mild-to-Moderate Asthma: A Case-Crossover Study Drug safety, 2026.PMID 42489820
25. [25]Couillard S, Meulmeester FL, Charland P, et al. Symptom burden to characterise, predict, and prevent asthma attacks: a patient-level meta-analysis of randomised trials and translational prospective studies The Lancet. Respiratory medicine, 2026.PMID 42624803
26. [26]Villamañán E, Laorden D, Carpio C, et al. Rescue Inhaler Overuse in Severe Asthma: A Real-World Study of Short-Acting β(2)-Agonist and Short-Acting Muscarinic Antagonist Use Biomedicines, 2026.PMID 42351760
27. [27]Gleeson M, McCarthy C, Shaughnessy FO, et al. Asthma management in pregnancy and lactation: A review of current evidence and best practice recommendations NPJ primary care respiratory medicine, 2026.PMID 41963344
28. [28]Flom JD, Srajer A, Zaeh SE, et al. Diagnosis and Management of Asthma During Pregnancy The journal of allergy and clinical immunology. In practice, 2026.PMID 41903880
29. [29]Nanda A, Baptist AP, Divekar R, et al. Asthma in the older adult The Journal of asthma : official journal of the Association for the Care of Asthma, 2020.PMID 30656998
30. [30]Walls JK, Marshall GD Jr Allergy and asthma in the elderly The American journal of the medical sciences, 2026.PMID 42140557
31. [31]Hadžić B, Vasbinder EC, Lek RM, et al. The Impact of Obesity on Airway Inflammation, Lung Function and Biologic Treatment in Asthma: A Narrative Review Journal of inflammation research, 2026.PMID 42273223
32. [32]Hearn AP, Slinger C, Butler JM, et al. Algorithms in Allergy: Diagnosis of Concomitant Inducible Laryngeal Obstruction in Adults With Asthma Allergy, 2026.PMID 42319194
33. [33]Calzetta L, Pistocchini E, Reverberi E, et al. Pharmacological Advances in Managing Exercise-Induced Bronchospasm: An Umbrella Review Following PRIOR Guideline Scandinavian journal of medicine & science in sports, 2026.PMID 41482990
34. [34]Sagayaraj MJ, Panneerselvam S, Jeganathan HR, et al. Advances in asthma-COPD overlap treatment: A comprehensive review of therapeutic approaches Respiratory medicine, 2025.PMID 41314438
35. [35]Anderson WC 3rd, Baptist AP, Eakin MN, et al. Adherence Challenges and Strategies in Specific Groups With Asthma: Adolescents, Pregnancy, and Older Adults The journal of allergy and clinical immunology. In practice, 2024.PMID 39122111
36. [36]Chan A, De Simoni A, Wileman V, et al. Digital interventions to improve adherence to maintenance medication in asthma The Cochrane database of systematic reviews, 2022.PMID 35691614
37. [37]Piątkowska A, Marszałek K, Krupińska N, et al. Shared decision making - a review of its evaluation, efficacy, and applicability in asthma Frontiers in medicine, 2025.PMID 40873791
38. [38]Chandrasekara S, Wark P Biologic therapies for severe asthma with persistent type 2 inflammation Australian prescriber, 2024.PMID 38737370
39. [39]Redfern JS, Smith MA A quarter-century of montelukast: clinical lessons for adult and pediatric asthma and allergic rhinitis care Current medical research and opinion, 2026.PMID 42466635
40. [40]Lo CWH, Pathadka S, Qin SX, et al. Neuropsychiatric events associated with montelukast in patients with asthma: a systematic review European respiratory review : an official journal of the European Respiratory Society, 2023.PMID 37758273
41. [41]McDonald VM, Archbold G, Beyene T, et al. Asthma and landscape fire smoke: A Thoracic Society of Australia and New Zealand position statement Respirology (Carlton, Vic.), 2023.PMID 37712340