Expert consensus on the management of mild and moderate asthma

Mild and moderate asthma are the most common forms of asthma, but they often remain poorly controlled due to inappropriate treatment strategies and low adherence. Formal consensus on best practices for managing mild-to-moderate asthma is still lacking.

To achieve formal consensus on the management of mild-to-moderate asthma and validate the appropriateness and clinical feasibility of the recommendations in clinical practice.

A modified Delphi process involving a panel of respiratory experts was employed to formulate consensus statements across the following key domains identified through a cross-sectional survey administered to Italian allergists and immunologists: definition of asthma control, tools for assessment of asthma control, patient phenotyping, personalized treatment, and patient education and empowerment. The appropriateness and clinical feasibility of the agreed statements were validated with a RAND/UCLA method.

Full consensus was reached on asthma control in mild-to-moderate asthma, defined as the absence of symptoms, exacerbations, limitation of daily activities, and the need for oral corticosteroids, together with the optimization of lung function. Assessment of control, future risk, and phenotype should be performed with appropriate tools and timing, to implement proactive management especially in patients at risk of exacerbations and disease progression.

This study provides a comprehensive, expert-driven consensus for the management of mild-to-moderate asthma, formally validated for appropriateness despite variability in real-world implementation. The findings support a patient-centric, proactive approach and offer practical recommendations to bridge the gap between guidelines and clinical practice.