GINA Global Strategy for Asthma Management and Prevention 2021 simplified.

Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention 2021

GINA was established by the WHO and NHLBI in 1993.

COVID-19 & Asthma

  • People with asthma do not appear to be at increased risk of acquiring COVID-19
  • Overall, people with well-controlled asthma are not at increased risk of COVID-19-related death
  • However, the risk of COVID-19 death was increased in people who had recently needed oral corticosteroids (OCS) for their asthma.
  • For patients with severe asthma, continue biologic therapy or oral corticosteroids if prescribed

About Asthma

  •  Asthma is the most common chronic non-communicable disease, affecting over 260 million people globally in 2019
  • Asthma is characterized by variable respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough, and variable expiratory airflow limitation. It is usually associated with airway inflammation 
  • People with asthma often have periods of worsening symptoms and worsening airway obstruction, called exacerbations (also called attacks or flare-ups), that can be fatal 
  • Most of the morbidity and mortality associated with asthma is preventable, particularly with use of inhaled corticosteroids 

In 2019 GINA brought some big changes like

  • GINA no longer recommends SABA-only treatment for Step 1 in adults and adolescents. This decision was based on evidence that SABA-only treatment increases the risk of severe exacerbations, and that adding any ICS significantly reduces the risk 
  • GINA now recommends that all adults and adolescents with asthma should receive ICS-containing controller treatment, to reduce the risk of serious exacerbations. The ICS can be delivered by regular daily treatment or, in mild asthma, by as-needed low dose ICS-formoterol

Starting Asthma Treatment

Step 1 Symptoms twice a month or more? RELIEVER: As-needed low-dose ICS formoterol
Step 2 Symptoms most days, or waking at night once a week or more? RELIEVER + Low dose maintenance ICS-formoterol
Step 3 Daily symptoms, waking at night once a week or more and low lung function? RELIEVER + Medium dose maintenance ICS-formoterol. Short course of Oral Corticosteroids maybe needed for patient presenting with severely uncontrolled Asthma
Step 4 Not improved by Step 3 treatment. RELIEVER + Add-on LAMA. Refer for phenotypic assessment ± anti-IgE, anti-IL5/5R, anti-IL4R.Consider high dose ICS-formoterol
 

Note: GINA 2021 does not distinguish between ‘intermittent’ and ‘mild persistent’ asthma.

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