Is It Time to Leave Behind the Concept of Asthma Control and Severity Steps?

After 25 years of GINA, we need an overarching strategy. The resounding changes in GINA 2019 should be accompanied by another major change in general strategy of asthma management. The concept of control asthma and step strategy was established in 1997 by GINA; but still there is a great gap between GINA objectives and outcomes. O'Byrne and colleagues proposed a continuum of care approach; where patient-adjusted therapy would comprise both a controller and reliever (usually ICS/fast-acting LABA) in a single inhaler. We use a similar approach in our asthma centre.