Guideline-driven and dependable management of asthma: an evidence-based systematic review

Our review examined recent evidence on asthma management, focusing on updated clinical guidelines, pharmacologic and non-pharmacologic treatment strategies, and population-specific considerations. Particular attention was given to the Global Initiative for Asthma and the National Heart, Lung, and Blood Institute guidelines.

We included peer-reviewed articles, clinical guidelines, systematic reviews, meta-analyses, randomized controlled trials, and cohort studies published in English from January 2018 to August 2024. Studies not focused on asthma management published before 2018 that were not in English or lacked relevant clinical content were excluded. Literature was identified via PubMed, Embase, Scopus, and the Cochrane Library searches. The GRADE framework assessed evidence quality across study design, consistency, and applicability. Due to heterogeneity in study designs and outcomes, a narrative synthesis was conducted.

Sixty-two studies met inclusion criteria, including clinical guidelines (n = 4), systematic reviews/meta-analyses (n = 14), randomized controlled trials (n = 18), cohort studies (n = 11), and expert reviews (n = 15). These addressed pharmacologic therapy, biologics, digital health tools, and care in specific populations. High-certainty evidence supports inhaled corticosteroid-based stepwise therapy and biologics for severe asthma. Moderate-certainty evidence supports digital tools and lifestyle interventions, while alternative therapies have low-certainty support. Biologics like dupilumab and benralizumab showed consistent reductions in severe asthma exacerbations.

Evidence was limited by heterogeneity, potential bias in lower-quality studies, and inconsistent outcome reporting. Findings affirm guideline-based therapy as foundational while highlighting the growing role of biologics and digital innovations.

Our review received no external funding and was not registered in a systematic review registry.