Essence of the Japanese Guidelines for Adult Asthma

  • Tomohiro IchikawaEmail author
  • Hisatoshi Sugiura
Part of the Respiratory Disease Series: Diagnostic Tools and Disease Managements book series (RDSDTDM)


The Japanese guidelines for adult asthma were first published in 1993 and have been updated every 3 years. The latest version of Japanese guidelines was updated in 2015 and the English version was published in 2017 (JGL 2017). In the latest guidelines, the definition, management, and treatment of asthma have been modified. In this chapter, we described the contents of the Japanese guidelines as compared to the Global Initiative for Asthma (GINA) guidelines, especially focusing on treatment. In the JGL, the initial treatment and long-term management of asthma have been based on a stepwise approach. In the JGL, determination of the treatment steps differs between untreated and treated patients. In stable asthma, the use of low dose inhaled corticosteroid is recommended for the initial treatment at step 1 treatment in JGL because the goal of asthma management in JGL is to eliminate the symptoms. In contrast, no controller drug is recommended as the basic treatment at the step 1 treatment in GINA. This chapter overviews the treatment plans for asthma management in the Japanese guidelines and discusses some differences in the approach from GINA.


Japanese guidelines for adult asthma Goal of asthma treatment Stepwise approach 


  1. 1.
    Ichinose M, Sugiura H, Nagase H, Yamaguchi M, Inoue H, Sagara H, et al. Japanese guidelines for adult asthma 2017. Allergol Int. 2017;66(2):163–89.CrossRefGoogle Scholar
  2. 2.
    Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention; 2017. Available from:
  3. 3.
    Ohashi Y, Motojima S, Fukuda T, Makino S. Airway hyperresponsiveness, increased intracellular spaces of bronchial epithelium, and increased infiltration of eosinophils and lymphocytes in bronchial mucosa in asthma. Am Rev Respir Dis. 1992;145(6):1469–76.CrossRefGoogle Scholar
  4. 4.
    Bousquet J, Chanez P, Lacoste JY, Barneon G, Ghavanian N, Enander I, et al. Eosinophilic inflammation in asthma. N Engl J Med. 1990;323(15):1033–9.CrossRefGoogle Scholar
  5. 5.
    Vignola AM, Chanez P, Campbell AM, Souques F, Lebel B, Enander I, et al. Airway inflammation in mild intermittent and in persistent asthma. Am J Respir Crit Care Med. 1998;157(2):403–9.CrossRefGoogle Scholar
  6. 6.
    Roche WR, Beasley R, Williams JH, Holgate ST. Subepithelial fibrosis in the bronchi of asthmatics. Lancet. 1989;1(8637):520–4.CrossRefGoogle Scholar
  7. 7.
    Tamura G, Sano Y, Hirata K, Ishioka S, Nakashima M, Miyamoto T. Effect of transdermal tulobuterol added to inhaled corticosteroids in asthma patients. Allergol Int. 2005;54(4):615–20.CrossRefGoogle Scholar
  8. 8.
    Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL, et al. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med. 2010;181(2):116–24.CrossRefGoogle Scholar
  9. 9.
    Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV, et al. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet. 2003;361(9363):1071–6.CrossRefGoogle Scholar
  10. 10.
    Drazen JM, Israel E, O’Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med. 1999;340(3):197–206.CrossRefGoogle Scholar
  11. 11.
    Sullivan P, Bekir S, Jaffar Z, Page C, Jeffery P, Costello J. Anti-inflammatory effects of low-dose oral theophylline in atopic asthma. Lancet. 1994;343(8904):1006–8.CrossRefGoogle Scholar
  12. 12.
    Lemanske RF Jr, Sorkness CA, Mauger EA, Lazarus SC, Boushey HA, Fahy JV, et al. Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmeterol: a randomized controlled trial. JAMA. 2001;285(20):2594–603.CrossRefGoogle Scholar
  13. 13.
    Greening AP, Ind PW, Northfield M, Shaw G, Allen & Hanburys Limited UK Study Group. Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Lancet. 1994;344(8917):219–24.CrossRefGoogle Scholar
  14. 14.
    Matsunaga K, Kawabata H, Hirano T, Sugiura H, Minakata Y, Ichinose M. Difference in time-course of improvement in asthma control measures between budesonide and budesonide/formoterol. Pulm Pharmacol Ther. 2013;26(2):189–94.CrossRefGoogle Scholar
  15. 15.
    Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJ, Pauwels RA, et al. Can guideline-defined asthma control be achieved? The gaining optimal asthma control study. Am J Respir Crit Care Med. 2004;170(8):836–44.CrossRefGoogle Scholar
  16. 16.
    Bjermer L, Bisgaard H, Bousquet J, Fabbri LM, Greening AP, Haahtela T, et al. Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults: one year, double blind, randomised, comparative trial. BMJ. 2003;327(7420):891.CrossRefGoogle Scholar
  17. 17.
    Nelson HS, Busse WW, Kerwin E, Church N, Emmett A, Rickard K, et al. Fluticasone propionate/salmeterol combination provides more effective asthma control than low-dose inhaled corticosteroid plus montelukast. J Allergy Clin Immunol. 2000;106(6):1088–95.CrossRefGoogle Scholar
  18. 18.
    Evans DJ, Taylor DA, Zetterstrom O, Chung KF, O’Connor BJ, Barnes PJ. A comparison of low-dose inhaled budesonide plus theophylline and high-dose inhaled budesonide for moderate asthma. N Engl J Med. 1997;337(20):1412–8.CrossRefGoogle Scholar
  19. 19.
    Humbert M, Beasley R, Ayres J, Slavin R, Hebert J, Bousquet J, et al. Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): INNOVATE. Allergy. 2005;60(3):309–16.CrossRefGoogle Scholar
  20. 20.
    Beasley R, Cushley M, Holgate ST. A self management plan in the treatment of adult asthma. Thorax. 1989;44(3):200–4.CrossRefGoogle Scholar
  21. 21.
    Bousquet J, Boulet LP, Peters MJ, Magnussen H, Quiralte J, Martinez-Aguilar NE, et al. Budesonide/formoterol for maintenance and relief in uncontrolled asthma vs. high-dose salmeterol/fluticasone. Respir Med. 2007;101(12):2437–46.CrossRefGoogle Scholar
  22. 22.
    Turner MO, Noertjojo K, Vedal S, Bai T, Crump S, Fitzgerald JM. Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma. Am J Respir Crit Care Med. 1998;157(6 Pt 1):1804–9.CrossRefGoogle Scholar
  23. 23.
    O’Driscoll BR, Kalra S, Wilson M, Pickering CA, Carroll KB, Woodcock AA. Double-blind trial of steroid tapering in acute asthma. Lancet. 1993;341(8841):324–7.CrossRefGoogle Scholar
  24. 24.
    Darioli R, Perret C. Mechanical controlled hypoventilation in status asthmaticus. Am Rev Respir Dis. 1984;129(3):385–7.PubMedGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Respiratory MedicineTohoku University Graduate School of MedicineSendaiJapan

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