8 New Updates and 11 Key Recommendations from the 2021 Canadian Thoracic Society Guidelines
Asthma affects 3.8 million Canadians over the age of 1. Approximately 28-40% of this
population have mild or very mild asthma.
NEW Features and Updates for Management (see full article for details)
Well controlled asthma now defined as daytime symptoms ≤ 2 days per week and PRN SABA use ≤ 2 doses, down from 4 and 4, respectively
Risk of exacerbation added as a new parameter for selecting optimal treatment
Criteria for classifying exacerbations as mild or severe clarified
Indications for initiating daily ICS clarified
New treatment option available for ≥ 12 years with well-controlled asthma
Severity classifications updated
ICS dosing table revised
Asthma continuum discussed
11 KEY Recommendations for Treatment
Recommended that control and exacerbation risk be assessed at each clinic visit
PRN SABA alone OR daily ICS + PRN SABA OR PRN budesonide/formoterol recommended for ≥ 12 years if well-controlled asthma with low risk for exacerbation
Daily ICS + PRN SABA OR PRN budesonide/formoterol recommended for those ≥ 12 with well-controlled asthma taking PRN SABA alone and if at high risk for exacerbations PRN budesonide/formoterol preferred if poor adherence.
PRN SABA OR daily ICS + PRN SABA (patient preference) recommended for children <12 years with well controlled asthma at low risk for exacerbation
Daily ICS + PRN SABA recommended for those aged <12 years with well controlled asthma and high risk of exacerbation
Recommended that patients on PRN SABA with well-controlled asthma at lower risk for exacerbations continue PRN SABA alone instead of in conjunction with ICS at the time of administration
Recommended that all patients with poorly controlled asthma on PRN SABA also take daily ICS instead of PRN SABA or PRN bud/form alone
PRN budesonide/formoterol recommended instead of daily ICS + PRN SABA for patients ≥12 years with poor adherence to medication
Recommended that patients on PRN SABA with poorly controlled asthma take daily ICS instead of taking ICS at the same time as SABA
Daily ICS AND PRN SABA recommended for all patients with poorly controlled asthma OR those on daily low dose ICS with well-controlled asthma
Short courses of very high-dose ICS with acute loss of asthma control NOT RECOMMENDED for patients on PRN SABA, irrespective of asthma control status
TAKE HOME MESSAGE
When considering mild and very mild asthma, PRN SABA +/- DAILY ICS recommended as first
line treatment, and BOTH together if at higher risk for exacerbations and if poorly controlled
disease.
New research has deemed PRN Budesonide/formoterol an effective additional or alternate
treatment option for those ≥12 years and is recommended as first line in cases of poor adherence.