Global guidelines for asthma management: summary of the current status and future challenges

The Global Initiative for Asthma (GINA) is an initiative started in the early 1990s to develop guidelines for asthma diagnosis and management that were applicable to both developed and developing countries. GINA now recommends that achieving overall asthma control is the goal of therapy. Overall asthma control consists of 2 domains: to achieve day-to-day (or current) asthma control and to minimize future risk measured by the absence of asthma exacerbations, the prevention of accelerated decline in lung function over time, and no side effects from medications. The GINA treatment paradigm consists of 5 treatment steps. At each step a preferred option and other alternatives are identified. Step 1 is as needed (prn) rapid-acting inhaled β2-agonist. The other 4 treatment steps include a controller option, ranging from low-dose inhaled corticosteroids (ICSs) as the preferred treatment option at Step 2, to high-dose ICSs plus long-acting inhaled β2-agonist combinations together with oral corticosteroids at Step 5. Once the level of asthma control has been established, consideration should be given to reducing the amount of treatment. By contrast, if asthma is uncontrolled, treatment needs to be increased to the next step. In an effort to remain current, a yearly update, based on an extensive review of the previous year's peer-reviewed literature on asthma management, is available on the web version of the GINA guidelines.