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 journalArticleAcademicpeer-review

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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.
Original languageEnglish
Pages (from-to)17-35
Number of pages19
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number1
Publication statusPublished - 1 Jan 2022

Bibliographical note

Funding Information:
Supported by the Global Initiative for Asthma (GINA). GINA is supported only by the sale and licensing of its reports and figures. These recommendations were developed by GINA and are not official guidelines from the American Thoracic Society. They have not been reviewed or endorsed by the American Thoracic Society Board of Directors.

Publisher Copyright:
Copyright © 2022 by the American Thoracic Society


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