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J Allergy Clin Immunol Pract. 2021 Oct 27; doi: 10.1016/j.jaip.2021.10.001. Epub 2021 Oct 27.

Global Initiative for Asthma (GINA) Strategy 2021 - Executive summary and rationale for key changes.

The journal of allergy and clinical immunology. In practice

Helen K Reddel, Leonard B Bacharier, Eric D Bateman, Christopher E Brightling, Guy G Brusselle, Roland Buhl, Alvaro A Cruz, Liesbeth Duijts, Jeffrey M Drazen, J Mark FitzGerald, Louise J Fleming, Hiromasa Inoue, Fanny W Ko, Jerry A Krishnan, Mark L Levy, Jiangtao Lin, Kevin Mortimer, Paulo M Pitrez, Aziz Sheikh, Arzu A Yorgancioglu, Louis-Philippe Boulet

Affiliations

  1. The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia.
  2. Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, TN, USA.
  3. Department of Medicine, University of Cape Town, Cape Town, South Africa.
  4. Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
  5. Ghent University Hospital, Ghent, Belgium and Erasmus MC University Medical CenterRotterdam, Rotterdam, the Netherlands.
  6. Pulmonary Department, Mainz University Hospital, Mainz, Germany.
  7. Federal University of Bahia, Salvador, BA, Brazil.
  8. Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  9. Brigham and Woman's Hospital and Harvard Medical School, Boston, MA, USA.
  10. University of British Columbia, Vancouver, BC, Canada.
  11. Imperial College, London, United Kingdom.
  12. Kagoshima University, Kagoshima, Japan.
  13. The Chinese University of Hong Kong, Hong Kong.
  14. Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, USA.
  15. Locum GP, London, UK.
  16. China-Japan Friendship Hospital, Peking University, Beijing, China.
  17. Liverpool School of Tropical Medicine, Liverpool, UK.
  18. Hospital Moinhos de Vento, Porto Alegre, Brazil.
  19. Usher Institute, The University of Edinburgh, United Kingdom.
  20. Celal Bayar University, Department of Pulmonology, Manisa, Turkey.
  21. Québec Heart and Lung Institute, Université Laval, Québec, QC, Canada.

PMID: 34718211 DOI: 10.1016/j.jaip.2021.10.001

Abstract

The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting beta2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by ≥60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has 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. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting beta2-agonist (LABA) (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age-groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment and review remain essential to optimize asthma outcomes.

Copyright © 2021. Published by Elsevier Inc.

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