Global Initiative for Asthma Strategy 2021
Executive Summary and Rationale for Key Changes
Helen K. Reddel1, Leonard B. Bacharier2, Eric D. Bateman3, Christopher E. Brightling4, Guy G. Brusselle5,6, Roland Buhl7, Alvaro A. Cruz8, Liesbeth Duijts9, Jeffrey M. Drazen10,11, J. Mark FitzGerald12, Louise J. Fleming13, Hiromasa Inoue14, Fanny W. Ko15, Jerry A. Krishnan16, Mark L. Levy17, Jiangtao Lin18, Kevin Mortimer19,20, Paulo M. Pitrez21, Aziz Sheikh22, Arzu A. Yorgancioglu23, and Louis-Philippe Boulet24,25 1TheWoolcock Institute of Medical Research and The University of Sydney, Sydney, Australia; 2Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee; 3Department of Medicine, University of Cape Town, Cape Town, South Africa; 4Leicester National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, United Kingdom; 5Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; 6Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; 7Pulmonary Department, Mainz University Hospital, Mainz, Germany; 8Federal University of Bahia, Salvador, Bahia, Brazil; 9Department of Pediatrics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; 10Divisions of Medical Communication and Pulmonary Medicine, Department of Medicine, Brigham andWoman’s Hospital, Boston, Massachusetts; 11Harvard Medical School, Boston, Massachusetts; 12University of British Columbia, Vancouver, British Columbia, Canada; 13Imperial College London, London, United Kingdom; 14Kagoshima University, Kagoshima, Japan; 15The Chinese University of Hong Kong, Hong Kong; 16Breathe Chicago Center, University of Illinois Chicago, Chicago, Illinois; 17Locum General Practitioner, London, United Kingdom; 18China–Japan Friendship Hospital, Peking University, Beijing, China; 19Department of Respiratory Medicine, Liverpool University Hospitals National Health Service Foundation Trust, United Kingdom; 20Department of Medicine, University of Cambridge, Cambridge, United Kingdom; 21Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil; 22Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; 23Department of Pulmonology, Celal Bayar University, Manisa, Turkey; and 24Institut universitaire de cardiologie et de pneumologie de Quebec and 25Departement de medecine, Université Laval,
Québec, Québec, Canada
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 b2-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 and 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 b2-agonist (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.
Keywords: asthma; asthma diagnosis; asthma management; asthma prevention
Para acessar a integra do artigo, click aqui
