Estrategia Global para el Manejo del Asma 2021. Resumen ejecutivo y razones de los cambios clave

Helen K. Reddel; Leonard B. Bacharier; Eric D. Bateman; Christopher E. Brightling; Guy G. Brusselle; Roland Buhl; Alvaro A. Cruz; Liesbeth Duijts; Jeffrey M. Drazen; J. Mark FitzGerald; Louise J. Fleming; Hiromasa Inoue; Fanny W. Ko; Jerry A. Krishnan; Mark L. Levy; Jiangtao Lin; Kevin Mortimer; Paulo M. Pitrez; Aziz Sheikh; Arzu A. Yorgancioglu; Louis Philippe Boulet

doi:10.1016/j.arbres.2021.10.003

Estrategia Global para el Manejo del Asma 2021. Resumen ejecutivo y razones de los cambios clave

Translated title of the contribution: Global Initiative for Asthma Strategy 2021. Executive Summary and Rationale for Key Changes

Helen K. Reddel^*, Leonard B. Bacharier, Eric D. Bateman, Christopher E. Brightling, Guy G. Brusselle, Roland Buhl, Alvaro A. Cruz, Liesbeth Duijts, Jeffrey M. Drazen, J. Mark FitzGerald, Louise J. Fleming, Hiromasa Inoue, Fanny W. Ko, Jerry A. Krishnan, Mark L. Levy, Jiangtao Lin, Kevin Mortimer, Paulo M. Pitrez, Aziz Sheikh, Arzu A. YorganciogluLouis Philippe Boulet

^*Corresponding author for this work

Research output: Contribution to journal › Short survey › Academic › peer-review

41 Citations (Scopus)

62 Downloads (Pure)

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 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
Original language	Spanish
Pages (from-to)	35-51
Number of pages	17
Journal	Archivos de Bronconeumologia
Volume	58
Issue number	1
DOIs	https://doi.org/10.1016/j.arbres.2021.10.003
Publication status	Published - Jan 2022

Bibliographical note

Acknowledgments:
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.

Publisher Copyright:
© 2021 American Thoracic Society

Access to Document

10.1016/j.arbres.2021.10.003

1-s2.0-S0300289621003471-mainFinal published version, 4.84 MB

Cite this

Reddel, H. K., Bacharier, L. B., Bateman, E. D., Brightling, C. E., Brusselle, G. G., Buhl, R., Cruz, A. A., Duijts, L., Drazen, J. M., FitzGerald, J. M., Fleming, L. J., Inoue, H., Ko, F. W., Krishnan, J. A., Levy, M. L., Lin, J., Mortimer, K., Pitrez, P. M., Sheikh, A., ... Boulet, L. P. (2022). Estrategia Global para el Manejo del Asma 2021. Resumen ejecutivo y razones de los cambios clave. Archivos de Bronconeumologia, 58(1), 35-51. https://doi.org/10.1016/j.arbres.2021.10.003

@article{418dd4941dca4bdda3e0fc94743798b1,

title = "Estrategia Global para el Manejo del Asma 2021. Resumen ejecutivo y razones de los cambios clave",

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 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.",

author = "Reddel, {Helen K.} and Bacharier, {Leonard B.} and Bateman, {Eric D.} and Brightling, {Christopher E.} and Brusselle, {Guy G.} and Roland Buhl and Cruz, {Alvaro A.} and Liesbeth Duijts and Drazen, {Jeffrey M.} and FitzGerald, {J. Mark} and Fleming, {Louise J.} and Hiromasa Inoue and Ko, {Fanny W.} and Krishnan, {Jerry A.} and Levy, {Mark L.} and Jiangtao Lin and Kevin Mortimer and Pitrez, {Paulo M.} and Aziz Sheikh and Yorgancioglu, {Arzu A.} and Boulet, {Louis Philippe}",

note = "Acknowledgments: 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{\textquoteright} 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. Publisher Copyright: {\textcopyright} 2021 American Thoracic Society",

year = "2022",

month = jan,

doi = "10.1016/j.arbres.2021.10.003",

language = "Spanish",

volume = "58",

pages = "35--51",

journal = "Archivos de Bronconeumologia",

issn = "0300-2896",

publisher = "Ediciones Doyma, S.L.",

number = "1",

}

Reddel, HK, Bacharier, LB, Bateman, ED, Brightling, CE, Brusselle, GG, Buhl, R, Cruz, AA, Duijts, L, Drazen, JM, FitzGerald, JM, Fleming, LJ, Inoue, H, Ko, FW, Krishnan, JA, Levy, ML, Lin, J, Mortimer, K, Pitrez, PM, Sheikh, A, Yorgancioglu, AA & Boulet, LP 2022, 'Estrategia Global para el Manejo del Asma 2021. Resumen ejecutivo y razones de los cambios clave', Archivos de Bronconeumologia, vol. 58, no. 1, pp. 35-51. https://doi.org/10.1016/j.arbres.2021.10.003

TY - JOUR

T1 - Estrategia Global para el Manejo del Asma 2021. Resumen ejecutivo y razones de los cambios clave

AU - Reddel, Helen K.

AU - Bacharier, Leonard B.

AU - Bateman, Eric D.

AU - Brightling, Christopher E.

AU - Brusselle, Guy G.

AU - Buhl, Roland

AU - Cruz, Alvaro A.

AU - Duijts, Liesbeth

AU - Drazen, Jeffrey M.

AU - FitzGerald, J. Mark

AU - Fleming, Louise J.

AU - Inoue, Hiromasa

AU - Ko, Fanny W.

AU - Krishnan, Jerry A.

AU - Levy, Mark L.

AU - Lin, Jiangtao

AU - Mortimer, Kevin

AU - Pitrez, Paulo M.

AU - Sheikh, Aziz

AU - Yorgancioglu, Arzu A.

AU - Boulet, Louis Philippe

N1 - Acknowledgments: 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. Publisher Copyright: © 2021 American Thoracic Society

PY - 2022/1

Y1 - 2022/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85122623530&partnerID=8YFLogxK

U2 - 10.1016/j.arbres.2021.10.003

DO - 10.1016/j.arbres.2021.10.003

M3 - Short survey

AN - SCOPUS:85122623530

SN - 0300-2896

VL - 58

SP - 35

EP - 51

JO - Archivos de Bronconeumologia

JF - Archivos de Bronconeumologia

IS - 1

ER -

Estrategia Global para el Manejo del Asma 2021. Resumen ejecutivo y razones de los cambios clave

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this