What are the 2025 guidelines for Gina regarding asthma management?

From the Guidelines

The 2025 guidelines for Gina regarding asthma management prioritize a control-based approach, with an emphasis on personalized treatment and regular assessment of symptoms, risk factors, comorbidities, inhaler technique, and adherence, as recommended by the most recent and highest quality study 1.

Key Recommendations

• The core treatment approach includes low-dose inhaled corticosteroids (ICS) with as-needed formoterol as preferred reliever therapy for most patients.
• For mild asthma, as-needed low-dose ICS-formoterol is recommended, while moderate-to-severe asthma typically requires daily maintenance ICS-LABA with as-needed ICS-formoterol as rescue.
• Specific medications include budesonide-formoterol and beclomethasone-formoterol combinations.
• Treatment adjustments should follow a control-based approach, stepping up when needed and considering step-down when asthma is well-controlled for 3 months.

Rationale

The rationale behind these recommendations is to reduce exacerbation risk while minimizing medication side effects, as even mild asthma carries inflammation risks, and SABA overuse is associated with increased exacerbation risk and mortality 1.

Important Considerations

• Severe asthma has been defined by the Global Initiative for Asthma (GINA) 2023 as asthma that is uncontrolled despite adherence with optimized high-dose ICS-long-acting beta agonist therapy and treatment of contributory factors or that worsens when high-dose treatment is decreased.
• Uncontrolled asthma has been associated with increased morbidity and mortality, emphasizing the need for regular assessment and personalized treatment 1.
• The guidelines emphasize the importance of written action plans, detailing medications and environmental control strategies tailored for each patient, and planned asthma-care visits to ensure adequate teaching and asthma control 2.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Asthma Management Guidelines for Gina in 2025

• The current guidelines for asthma management, as per the 2024 update from the Global Initiative for Asthma (GINA) 3, advise 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.
• 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.
• It is recommended that individuals with asthma 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.
• Previous guidelines suggested that patients with mild asthma symptoms could be managed with as-needed short-acting β2-agonists (SABA) 4, but this approach has been updated to recommend as-needed low-dose inhaled corticosteroid (ICS)-formoterol or "additional low-dose ICS taken whenever SABA is taken" treatments to relieve and control symptoms 4.
• The use of long-acting beta2-adrenergic agonists in asthma management is also recommended, particularly for patients whose asthma is not well controlled with inhaled corticosteroid monotherapy 5.

Inhaled Corticosteroid Doses

• The Global Initiative for Asthma guidelines use the traditional terminology of "low," "medium," and "high" doses of inhaled corticosteroids (ICS) to define daily maintenance doses of 100 to 250 μg, >250 to 500 μg, and >500 μg, respectively, of fluticasone propionate or equivalent for adults with asthma 6.
• However, it is proposed that this terminology is not evidence-based and that prescribing practice based on this terminology may lead to the use of inappropriately excessive doses of ICS 6.
• A reclassification of ICS doses based on a "standard daily dose," which is defined as 200-250 μg of fluticasone propionate or equivalent, is recommended, representing the dose at which approximately 80-90% of the maximum achievable therapeutic benefit of ICS is obtained in adult asthma across the spectrum of severity 6.

Combination Therapy

• The combination of fluticasone and formoterol in a single hydrofluoroalkane-based aerosol (flutiform®; fluticasone propionate/formoterol fumarate) has been shown to be effective in the treatment of asthma 7.
• This combination therapy has been demonstrated to be more efficacious than fluticasone or formoterol given alone, and provides similar improvements in lung function to fluticasone and formoterol administered concurrently via separate inhalers 7.