ARTICLE IN PRESSAllergology Intemational xxx(xxx)xxxContents lists available at ScienceDirectAllergology Internationaljournal homepage:http://www.elsevier.com/locate/alitInvited Review ArticleExecutive summary:Japanese guidelines for adult asthma (JGL)2021Akio Niimi,Koichi Fukunaga,Masami Taniguchi,Yoichi Nakamura,Etsuko Tagaya Takahiko Horiguchi Akihito Yokoyama Masao YamaguchiMakoto NagataDepartment of Respiratory Medicine,Allergy and Cinical Immunology.Nagoya City University Graduate School of Medical Sciences,Nagoya.JapanPulmonary Division.Department of Medicine.Keio University School of Medicine.Tokyo.JapanCenter for Immunology and Allergology,Shonan Kamakura General Hospital,Kanagawa,Japand Medical Center for Allergic and Immune Diseases,Yokohama City Minato Red Cross Hospital,Yokohama,Japane Department of Respiratory Medicine,Tokyo Women's Medical University.Tokyo,JapanDepartment of Respiratory Medicine,Toyota Regional Medical Center.Toyota.JapanDepartment of Respiratory Medicine and Allergology.Kochi Medical School,Kochi University.Kochi.JapanDivision of Respiratory Medicine.Third Department of Medicine.Teikyo University Chiba Medical Center.Chiba.JapanDepartment of Respiratory Medicine,Saitama Medical University.Saitama,JapanAllergy Center,Saitama Medical University Hospital,Saitama Medical University.Saitama,JapanARTIC LE INFOABSTRACTArticle history:Asthma is characterized by chronic airway inflammation,variable airway narrowing,and sensory nerveReceived 17 February 2023irritation,which manifest as wheezing.dyspnea,chest tightness,and cough.Longstanding asthma mayAccepted 17 February 2023result in airway remodeling and become intractable.Despite the increased prevalence of asthma inAwailable online xxxadults,asthma-associated deaths have decreased in Japan (0.94 per 100,000 people in 2020)The goals ofasthma treatment include the control of symptoms and reduction of future risks.A functional partner-Keyords:ship between physicians and patients is indispensable for achieving these goals.Long-term managementAsthmaExacerbationwith medications and the elimination of triggers and risk factors are fundamental to asthma treatment.Long-term managementAsthma is managed via four steps of pharmacotherapy ("controllers").ranging from mild to intensiveRisk factorstreatments,depending on disease severity:each step involves daily administration of an inhaled corti-Stepwise treatmentcosteroid,which varies from low to high dosage.Long-acting B2 agonists,leukotriene receptor antago-nists,sustained-release theophylline,and long-acting muscarinic antagonists are recommended as add-on drugs.Allergen immunotherapy is a new option that is employed as a controller treatment.Further,asof 2021,anti-IgE antibody.anti-IL-5 and anti-IL-5 receptor a-chain antibodies,and anti-IL-4 receptorchain antibodies are available for the treatment of severe asthma.Bronchial thermoplasty can be per-formed for asthma treatment,and its long-term efficacy has been reported.Algorithm
