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Publications

Journal Article Ahead of print

PubMed: 42562236 DOI: 10.1016/j.rmed.2026.109078

Expert consensus on the Management of Mild and Moderate Asthma.

Respir Med

Authors: Matteo Martini, Lorenzo Cecchi, Antonino Musarra, Kliljeda Jaubashi, Alessandro Maria Marra, Francesco Murzilli, Francesco Papia, Giuseppe Valenti, Baoran Yang, Mario Cazzola, Adriano Vaghi, Maria Beatrice Bilò

Affiliations

  • Allergy Unit, Department of Internal Medicine, University Hospital AOU Delle Marche, Ancona, Italy.
  • Allergy and Immunology Unit, San Giovanni di Dio Hospital, USL Toscana centro, Florence, Italy.
  • Allergy Unit, Casa della Salute di Scilla, Reggio Calabria, Italy.
  • Pulmonology Unit, ASST Santi Paolo Carlo, Milan Italy.
  • Pulmonology Unit, ASST Rhodense, Garbagnate Milanese Hospital, Milan, Italy.
  • Allergy Unit, SS Filippo e Nicola Hospital, Avezzano, Italy.
  • Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy.
  • Allergy Clinical Immunology and Rheumatology Unit, ASST Carlo Poma, Mantua, Italy.
  • Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy.
  • Former Head of Pneumology and Chief of the Department of Medicine and Rehabilitation, Guido Salvini Hospital-ASST Rhodense, Garbagnate Milanese (Milan), Italy.
  • Allergy Unit, Department of Internal Medicine, University Hospital AOU Delle Marche, Ancona, Italy; Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy.

Abstract

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

Full consensus was reached on asthma control in mild-to-moderate asthma, defined as the absence of symptoms, exacerbations, limitation of daily activities, and oral corticosteroids, and 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.

CONCLUSION

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.

MeSH

Patient Compliance, Therapeutics, Asthma