Global Initiative for Asthma (GINA) strategy 2021 - executive summary and rationale for key changes.
File(s)
Published version
OA Location
Author(s)
Type
Journal Article
Abstract
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting beta2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by ≥60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults/adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as-needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS formoterol (maintenance-and-reliever therapy, MART) in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting beta2-agonist (LABA) (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age-groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment and review remain essential to optimize asthma outcomes.
Date Issued
2021-10-18
Date Acceptance
2021-10-01
Citation
American Journal of Respiratory and Critical Care Medicine, 2021, 205 (1), pp.17-35
ISSN
1073-449X
Publisher
American Thoracic Society
Start Page
17
End Page
35
Journal / Book Title
American Journal of Respiratory and Critical Care Medicine
Volume
205
Issue
1
Copyright Statement
© 2021 by the American Thoracic Society. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/34658302
Subjects
Asthma
Asthma diagnosis
Asthma management
Asthma prevention
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2021-10-18