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Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes.
Helen K Reddel1, Leonard B Bacharier2, Eric D Bateman3
1The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia.
The Journal of Allergy and Clinical Immunology. in Practice
|October 31, 2021
Summary
The Global Initiative for Asthma (GINA) strategy now advises against using short-acting beta2-agonists (SABAs) alone for asthma. Preferred treatment involves inhaled corticosteroids (ICS) with formoterol for better asthma control and reduced exacerbations.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Guidelines
Background:
- The Global Initiative for Asthma (GINA) Strategy Report offers annual updates for evidence-based asthma management.
- Previous guidelines allowed short-acting beta2-agonist (SABA) monotherapy, posing risks.
- Recent evidence highlights the benefits of inhaled corticosteroids (ICS) in asthma management.
Purpose of the Study:
- To summarize key recommendations from the GINA 2021 Strategy Report.
- To outline recent changes in asthma management guidelines.
- To emphasize evidence supporting updated asthma treatment strategies.
Main Methods:
- Review of large clinical trials and evidence underpinning GINA 2021 recommendations.
- Analysis of updated treatment figures for adults, adolescents, and children.
- Inclusion of new recommendations for moderate-to-severe asthma and severe asthma.
Main Results:
- GINA 2021 discourages SABA-only treatment due to risks and SABA overuse.
- As-needed ICS-formoterol significantly reduces exacerbations in mild asthma compared to SABA alone.
- Treatment strategies are now divided into preferred (ICS-formoterol reliever) and alternative (SABA reliever) tracks.
Conclusions:
- Asthma management should prioritize ICS-based reliever therapy over SABA-only approaches.
- GINA 2021 provides updated, stepwise treatment options for various asthma severities and age groups.
- Personalized assessment, risk factor management, and self-management remain crucial for optimal asthma outcomes.
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