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Symptom versus exacerbation control: an evolution in GINA guidelines?
Manuela Latorre1, Riccardo Pistelli2, Giovanna Elisiana Carpagnano3
1Nuovo Ospedale Apuano, Massa, Italy.
Therapeutic Advances in Respiratory Disease
|August 30, 2023
Summary
Asthma management has evolved, with GINA guidelines now prioritizing exacerbation prevention and symptom control for better outcomes. Achieving good symptom control is key to reducing exacerbations and improving long-term asthma management.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Clinical Medicine
Background:
- The Global Initiative for Asthma (GINA) guidelines have evolved over 25 years.
- Early asthma management focused on controlling all clinical and functional aspects.
- The GOAL study demonstrated that good asthma control is achievable with regular treatment.
Purpose of the Study:
- To trace the evolution of asthma control concepts within GINA guidelines.
- To highlight the shift in focus towards exacerbation prevention and risk reduction.
- To analyze the relationship between symptom control and exacerbations in different asthma severities.
Main Methods:
- Review of GINA guidelines from 1995 to 2021.
- Analysis of landmark studies influencing asthma management strategies.
- Examination of the interplay between daily symptoms, exacerbations, and treatment adherence.
Main Results:
- Asthma management goals shifted from comprehensive control to emphasizing exacerbation prevention.
- GINA 2019 and 2021 updates prioritize exacerbation prevention, especially in mild asthma.
- Persistent poor symptom control is a risk factor for exacerbations; symptom control reduces exacerbation rates.
Conclusions:
- Asthma management now centers on preventing exacerbations and achieving acceptable symptom control with minimal rescue medication.
- Patient education on symptom perception and treatment adherence is crucial.
- Underlying risk factors, like airway inflammation, require consideration even with minor symptoms.
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