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The Clinical Practice Guideline for the Primary Care Management of Asthma from the Department of Veterans Affairs and Department of Defense recommends using newer, fast-onset medications and one inhaler rather than two for maintenance and rescue needs.
These combination medications are called Single Maintenance and Reliever Therapy, or SMART or MART, explained Maj. (Dr.) Jonathan Schroeder. He is chief of pediatric pulmonology and medical director of the Cystic Fibrosis Center at Brooke Army Medical Center in San Antonio, Texas.
SMART or MART is a newer treatment approach for asthma that uses a single inhaler containing both long-acting anti-inflammatory and rescue medicine. Traditional asthma management typically involves separate inhalers for daily maintenance and quick symptom relief.
“Based on those trends, and also the fact that we feel a lot of providers are moving toward that, or curious about SMART, we wanted the guideline to best reflect that and to fulfill what providers need,” Schroeder said.
To address this increasingly common disease, DOD and VA health care experts issued the revised clinical practice guideline in March 2025, providing critical decision points in asthma management and 21 evidence-based recommendations incorporating new information and care suggestions for primary care practitioners. The DOD and VA routinely update CPGs as new evidence-based research emerges and further advancements in medicine evolve.
Addressing the common breathing condition
Asthma constricts the air passages in the lungs, causing wheezing, coughing, shortness of breath, chest tightness, difficulty sleeping, fatigue, or a weak feeling. Sometimes, asthma can be severe or life-threatening, requiring hospitalization and a regimen of aerosolized breathing treatments to calm it down.
More than 20 million U.S. adults and 5 million children have asthma based on the National Health Interview Survey from the Centers for Disease Control and Prevention.
Schroeder served as one of two Defense Health Agency pulmonology champions on the working group for the new CPG. The group’s “goal was to produce guidelines that just about every general provider in both DHA and VA can use to treat asthma, because asthma is so common,” he said.
A cross-functional working group of VA and DOD experts created the new CPG with oversight through the DHA Office of Evidence-Based Practice. “There are so many different takes and different approaches toward asthma, so we wanted to keep things simple,” Schroeder explained. “That’s why we ended up building off of the 2019 guidelines.” This process included expanding recommendations on research needed to strengthen future guidelines. Experts reviewed new data collected up to May 2024.
The guidelines were updated partly because the Food and Drug Administration approved new medications or combinations of medications for quick relief during asthma attacks and maintenance drugs intended to improve lung function all day with one use in the morning.
For example, albuterol, an inhaled, short-acting beta agonist (also called a SABA) has been a standard rescue medication that quickly opens up the airways when you’re having an asthma attack. “It's still guidance not to put a patient on that therapy alone,” Schroeder pointed out.
Asthmatics often use albuterol in combination with an inhaled steroid, but now providers are moving toward long-acting beta agonists, or LABAs, that work quickly. Now, “we can put a patient potentially on one inhaler that is actually easier to use,” explained Schroeder, adding the convenience of only one inhaler instead of two means increased patient compliance.
The clinical practice guideline for asthma includes suggestions for:
New guidelines for asthma in the military
Service members are commonly diagnosed with asthma as adults after they’ve joined the military, according to the guideline, with causes including deployment-related exposures and increased smoking rates among active duty personnel compared to civilian counterparts. The CPG cites higher rates of new-onset asthma in service members who deployed to the Middle East during Operation Enduring Freedom and Operation Iraqi Freedom.
“This makes it likely that primary care providers in both the DOD and VA will encounter patients with a diagnosis of asthma or with symptoms suggestive of the diagnosis that will warrant evaluation and treatment,” according to the guideline. DHA added new provider training requirements on toxic exposure and burn pits in June 2025.
Additional sections deal with care management for asthma patients, such as using solutions-based behavioral therapy, identifying other adjacent medical conditions, how well the patient can afford medications, and family support, and lifestyle changes, such as quitting smoking or vaping, and regularly exercising.
The working group advised short-term follow-up should a patent have medical changes related to their asthma, including increasing use of rescue inhalers or a recent emergency room visit or hospitalization.
The guideline also addresses when patients should see a specialist. They include suspected job-related asthma, side effects, and symptoms that may be signs of a sub-type of asthma called eosinophilia.
Provider resources Clinical support tools for practitioners and patients include:
Additional training via a https://www.train.org/vha/course/1129944/details describes current therapeutic guidelines, best practices, and clinical evidence.
| Date Taken: | 01.13.2026 |
| Date Posted: | 01.13.2026 10:39 |
| Story ID: | 556131 |
| Location: | US |
| Web Views: | 35 |
| Downloads: | 0 |
This work, Asthma management clinical practice guideline revisions include single-inhaler approach, by Janet A. Aker, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
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