What are the highlights for the Global Initiative for Asthma (GINA) guidelines for asthma management?

From the Guidelines

The Global Initiative for Asthma (GINA) guidelines recommend a comprehensive approach to asthma management, emphasizing as-needed low-dose ICS-formoterol as the preferred reliever for all adults and adolescents, and a stepwise approach for controller therapy starting with low-dose inhaled corticosteroids (ICS). The guidelines highlight the importance of personalized asthma action plans, regular assessment of symptom control, and evaluation of risk factors for exacerbations 1. Key aspects of the GINA guidelines include:

• Recommendation against SABA-only treatment for adults and adolescents
• Use of as-needed low-dose ICS-formoterol as the preferred reliever
• Stepwise approach for controller therapy, starting with low-dose ICS such as budesonide or fluticasone, with options to add LABAs like formoterol or salmeterol as needed
• Emphasis on correct inhaler technique, medication adherence, and addressing modifiable risk factors such as smoking and allergen exposure
• Recommendation of biologics targeting specific inflammatory pathways for severe asthma, after optimizing high-dose ICS-LABA therapy 1. The GINA guidelines promote regular follow-up every 3-12 months depending on control level, with lung function testing to objectively assess airflow limitation, recognizing asthma as a heterogeneous condition requiring individualized treatment based on symptom control and risk assessment. The most recent guidelines prioritize a patient-centered approach, focusing on achieving well-controlled asthma through a stepwise approach to pharmacological management.

From the Research

GINA Guidelines for Asthma Highlights

• The 2019 Global Initiative for Asthma (GINA) guidelines recommend that all asthma patients be treated with inhaled corticosteroids taken daily or as needed, which improves symptoms and outcomes, even in those with mild disease 2
• Asthma management requires a stepwise approach, escalating and de-escalating treatment based on symptom control 2
• The current 2024 GINA update advises that all adults and adolescents with asthma receive inhaled corticosteroid (ICS)-containing medication and should not be treated with short-acting beta agonist (SABA) alone 3
• The 2024 GINA strategy divides treatment into two 'Tracks": Track 1 (preferred Track), the reliever is as-needed combination low-dose ICS-formoterol; Track 2 uses SABA as the reliever along with a separate ICS inhaler 3

Key Recommendations

• Inhaled corticosteroids (ICSs) and long-acting inhaled beta(2)-agonists (LABAs) are recommended treatment options for asthma 4
• Single inhaler combination regimens (budesonide/formoterol and fluticasone/salmeterol) were frequently more effective in improving all treatment outcomes than either monotherapy alone 4
• The addition of long-acting inhaled beta2-agonists to inhaled steroids as first-line therapy for persistent asthma in steroid-naive adults does not significantly reduce the rate of exacerbations over that achieved with inhaled corticosteroids alone 5

Treatment Approach

• Asthma should be controlled with anti-inflammatory therapeutic strategies, so that the as-needed requirement for inhaled beta2-agonists should be infrequent 6
• Individuals with asthma should have a written asthma action plan, and asthma management should be tailored to the individual to help reduce the occurrence of serious exacerbations, fatalities, and hospitalizations 3