What are the recommendations for managing asthma according to GINA (Global Initiative for Asthma) guidelines?

From the Guidelines

The GINA guidelines recommend a comprehensive approach to asthma management, emphasizing environmental trigger control, patient education, monitoring of pulmonary function, and individualized pharmacological treatment. According to the guidelines, the management of asthma should involve identifying and controlling exposure to environmental triggers, educating patients to take responsibility for day-to-day management, monitoring pulmonary function, and using pharmacological treatment based on the degree of severity of asthma 1.

Key Recommendations

• Exposure to environmental triggers must be identified and controlled
• Patient education is crucial for day-to-day management
• Monitoring of pulmonary function is essential for objective measurement of changing airway obstruction
• Pharmacological treatment should be individualized and based on the degree of severity of asthma

Pharmacological Treatment

The choice of medications depends on the degree of severity of asthma, with short-acting aerosol β2-adrenergic agonists being the primary treatment to relieve symptoms 1. However, if these are needed more than a few times a week, addition of an aerosol anti-inflammatory corticosteroid is recommended to control the chronic airway inflammation.

Stepwise Approach

While the provided study 1 does not explicitly outline a stepwise approach, the general principle of adjusting treatment based on severity and response is emphasized. This typically involves starting with low-intensity treatment and stepping up as needed, with regular reassessment to adjust treatment accordingly.

Patient Education and Self-Management

Patient education and self-management are critical components of asthma care, as they enable patients to recognize symptoms, use medications correctly, and seek medical attention when necessary 1. Proper inhaler technique training is also essential to ensure effective medication delivery.

Conclusion is not allowed, so the response ends here.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

GINA Guidelines for Asthma Management

The Global Initiative for Asthma (GINA) guidelines provide recommendations for managing asthma, including the use of controller medications and rescue medication. According to the guidelines, asthma management should be based on a stepwise therapeutic approach, with the administration of controller medications (especially inhaled corticosteroids) complemented by on-demand use of rescue medication 2.

Recommendations for Mild Asthma

For patients with mild asthma (GINA step 1 and 2), the guidelines recommend the following:

• As-needed low-dose inhaled corticosteroid (ICS)-formoterol or "additional low-dose ICS taken whenever SABA is taken" treatments should be commenced to relieve and control symptoms 3.
• Daily low-dose ICS or ICS-LABA as needed is recommended as a first option for step 2 patients 2.
• Symptom-driven or as-needed treatment with ICS-LABA is recommended rather than SABA alone for step 1 patients 2.

Recommendations for Moderate to Severe Asthma

For patients with moderate to severe asthma, the guidelines recommend the following:

• Low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5 4.
• As-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting β2-agonist (Steps 3-5) is an alternative option 4.

Key Changes in GINA 2021

The GINA 2021 guidelines include the following key changes:

• Division of the treatment figure for adults and adolescents into two tracks: Track 1 (preferred) and Track 2 (alternative) 4.
• Recommendation of add-on long-acting muscarinic antagonists and azithromycin for adults with moderate-to-severe asthma, and add-on biologic therapies for severe asthma 4.
• New treatment options are added at Steps 3-4 for children 6-11 years 4.

Use of Leukotriene Receptor Antagonists

Leukotriene receptor antagonists (LTRAs) are recommended for the treatment of moderate and mild asthma, and can be used as monotherapy in patients with mild persistent asthma or as an add-on therapy in patients with moderate asthma not completely controlled with inhaled corticosteroids 5.

Some key points to consider when managing asthma according to GINA guidelines include:

• Regular personalized assessment and treatment of modifiable risk factors 4
• Self-management education and skills training 4
• Appropriate medication adjustment and review 4
• The use of as-needed ICS-LABA instead of SABA on request for GINA step 1 or as a replacement for chronic ICS in GINA step 2 is recommended, but the evidence for this is not conclusive 2, 6, 3, 4