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 β2-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 β2-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.
|Translated title of the contribution||Global Initiative for Asthma Strategy 2021. Executive Summary and Rationale for Key Changes|
|Number of pages||17|
|Journal||Archivos de Bronconeumologia|
|Publication status||Published - Jan 2022|
The authors thank Rebecca Decker, GINA Executive Director, and Kristi Rurey, GINA Project Manager, for supporting and coordinating the GINA Science Committee and Board, Dr. Ruth Hadfield for assistance with literature research, GINA Advocates and Assembly members across many countries for identifying clinicians’ needs and concerns, Kate Chisnall for assistance with graphics, and Jennifer Harman for editorial assistance. They thank Richard Beasley, Alan Kaplan, Hugo Neffen, Michael Schatz, Hesham Tarrif, and Richard van Zyl-Smit for their helpful review of the manuscript. They acknowledge the outstanding and dedicated work of Dr. Suzanne Hurd as Scientific Director of GINA and Dr. Claude Lenfant as Executive Director, from the inception of GINA in 1993 until their retirement in 2015.
© 2021 American Thoracic Society