From the Guidelines
The Global Initiative for Asthma (GINA) guidelines recommend a stepwise approach to pharmacological treatment, emphasizing the importance of achieving good control and reducing exacerbation risk, as outlined in the 2019 GINA algorithm 1. The GINA guidelines provide a comprehensive framework for asthma management, focusing on symptom control and risk factors. For initial treatment, GINA recommends low-dose inhaled corticosteroids (ICS) plus formoterol as needed, or regular daily low-dose ICS with as-needed short-acting beta-agonists (SABAs) 1.
Key Recommendations
- Low-dose ICS medications, such as fluticasone, budesonide, and beclomethasone, are typically used as initial treatment
- Treatment escalation involves increasing ICS dose, adding long-acting beta-agonists (LABAs), or incorporating other controllers like leukotriene receptor antagonists (montelukast)
- Severe asthma may require biologics targeting specific inflammatory pathways
- Regular assessment of symptom control, inhaler technique, adherence, and written asthma action plans is crucial The GINA guidelines emphasize the importance of recognizing asthma as an inflammatory condition requiring anti-inflammatory treatment, even in mild cases, to reduce exacerbation risk and prevent airway remodeling 1.
From the Research
Overview of GINA Guidelines
- The Global Initiative for Asthma (GINA) guidelines provide recommendations for the management of asthma, with updates released regularly to reflect the latest evidence-based practices 2, 3, 4, 5, 6.
- The 2019 GINA guidelines introduced significant changes to the treatment of intermittent and mild asthma, emphasizing the importance of inhaled corticosteroids (ICS) in reducing the risk of serious asthma exacerbations and asthma-related deaths 2, 3, 4.
Key Recommendations
- All adults and adolescents with mild asthma should receive either symptom-driven or daily low-dose ICS, rather than treatment with a short-acting β2 agonist (SABA) alone 2, 5, 6.
- The 2024 GINA update advises against treating asthma with SABA alone and recommends the use of ICS-containing medication for all adults and adolescents with asthma 5.
- The guidelines divide treatment into two "Tracks": Track 1 (preferred) uses as-needed combination low-dose ICS-formoterol, while Track 2 uses SABA as the reliever along with a separate ICS inhaler 5.
Treatment Approach
- A stepwise approach to asthma management is recommended, with treatment escalated or de-escalated based on symptom control 4.
- Individuals with asthma should have a written asthma action plan, and management should be tailored to the individual to reduce the occurrence of serious exacerbations, fatalities, and hospitalizations 5.
- The use of symptom-driven (as-needed) low-dose ICS-formoterol is supported as a risk reduction-based strategy in mild asthma patients, particularly those with poor adherence to controller medications 6.