From the Guidelines
The GINA guidelines for asthma management recommend a stepwise approach to treatment based on symptom control and risk factors, with a focus on personalized treatment and regular assessment to minimize medication side effects and improve quality of life.
Key Recommendations
- For mild asthma, GINA no longer recommends using short-acting beta-agonists (SABAs) alone, instead advocating for as-needed low-dose inhaled corticosteroid (ICS)-formoterol as the preferred reliever, or regular low-dose ICS with as-needed SABA 1.
- For persistent asthma, daily low-dose ICS plus as-needed SABA or as-needed ICS-formoterol is recommended as initial controller treatment.
- Treatment intensity increases through five steps, adding long-acting beta-agonists (LABAs), higher ICS doses, and potentially tiotropium, biologics (like omalizumab, mepolizumab, or dupilumab), or oral corticosteroids for severe cases.
Non-Pharmacological Strategies
- Trigger avoidance
- Smoking cessation
- Regular physical activity
- Weight management for obese patients
Importance of Regular Assessment
- Regular assessment of symptom control, risk factors, comorbidities, inhaler technique, and adherence is crucial, with treatment adjustments every 2-3 months 1.
- This stepwise approach allows for personalized treatment that can be stepped up when asthma is uncontrolled or stepped down when control is maintained for 3 months, ensuring patients receive appropriate treatment intensity while minimizing medication side effects. The guidelines emphasize the importance of patient education and self-management, as outlined in earlier guidelines 1, but the most recent and highest quality study 1 provides the foundation for current recommendations.
From the Research
GINA Guidelines for Asthma Management
The Global Initiative for Asthma (GINA) provides evidence-based guidelines for asthma management, which are updated annually. The guidelines recommend the following:
- All adults, adolescents, and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations 2, 3, 4, 5.
- Asthma treatment should be individualized, with regular assessment, adjustment, and review of treatment 2, 3, 4, 5.
- The treatment approach should be divided into two tracks: Track 1 (preferred) with low-dose ICS-formoterol as the reliever, and Track 2 (alternative) with as-needed SABA and regular ICS 3, 4.
- For adults with moderate-to-severe asthma, additional recommendations include add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma 3.
- Children 6-11 years have new treatment options added at Steps 3-4 3.
- A written asthma action plan is essential for individuals with asthma, and asthma management should be tailored to the individual to reduce the occurrence of serious exacerbations, fatalities, and hospitalizations 4.
Key Recommendations
The GINA guidelines emphasize the importance of:
- Inhaled corticosteroids as the foundation of asthma treatment 2, 3, 4, 5.
- Avoiding treatment with short-acting beta agonist (SABA) alone 3, 4.
- Regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, and appropriate medication adjustment 2, 3, 4.
- A stepwise approach to asthma management, escalating and de-escalating treatment based on symptom control 5.
Treatment Approach
The GINA guidelines recommend a treatment approach that takes into account the individual's symptoms, lung function, and quality of life. The approach should be flexible and adaptable to the individual's needs, with regular review and adjustment of treatment as needed 2, 3, 4, 5.