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Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes.

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cam.issuedOnline2022-01-12
dc.contributor.authorReddel, Helen K
dc.contributor.authorBacharier, Leonard B
dc.contributor.authorBateman, Eric D
dc.contributor.authorBrightling, Christopher E
dc.contributor.authorBrusselle, Guy G
dc.contributor.authorBuhl, Roland
dc.contributor.authorCruz, Alvaro A
dc.contributor.authorDuijts, Liesbeth
dc.contributor.authorDrazen, Jeffrey M
dc.contributor.authorFitzGerald, J Mark
dc.contributor.authorFleming, Louise J
dc.contributor.authorInoue, Hiromasa
dc.contributor.authorKo, Fanny W
dc.contributor.authorKrishnan, Jerry A
dc.contributor.authorLevy, Mark L
dc.contributor.authorLin, Jiangtao
dc.contributor.authorMortimer, Kevin
dc.contributor.authorPitrez, Paulo M
dc.contributor.authorSheikh, Aziz
dc.contributor.authorYorgancioglu, Arzu A
dc.contributor.authorBoulet, Louis-Philippe
dc.contributor.orcidReddel, Helen K [0000-0002-6695-6350]
dc.contributor.orcidBacharier, Leonard B [0000-0003-0432-2704]
dc.contributor.orcidBateman, Eric D [0000-0002-5064-5849]
dc.contributor.orcidBrightling, Christopher E [0000-0002-9345-4903]
dc.contributor.orcidBrusselle, Guy G [0000-0001-7021-8505]
dc.contributor.orcidDuijts, Liesbeth [0000-0001-6731-9452]
dc.contributor.orcidDrazen, Jeffrey M [0000-0003-2715-9890]
dc.contributor.orcidFitzGerald, J Mark [0000-0002-5367-5226]
dc.contributor.orcidFleming, Louise J [0000-0002-7268-7433]
dc.contributor.orcidInoue, Hiromasa [0000-0001-8080-3812]
dc.contributor.orcidKo, Fanny W [0000-0001-8454-0087]
dc.contributor.orcidKrishnan, Jerry A [0000-0001-5525-4778]
dc.contributor.orcidLevy, Mark L [0000-0002-1807-3246]
dc.contributor.orcidLin, Jiangtao [0000-0002-0228-572X]
dc.contributor.orcidMortimer, Kevin [0000-0002-8118-8871]
dc.contributor.orcidPitrez, Paulo M [0000-0001-7319-1133]
dc.contributor.orcidSheikh, Aziz [0000-0001-7022-3056]
dc.contributor.orcidYorgancioglu, Arzu A [0000-0002-4032-0944]
dc.contributor.orcidBoulet, Louis-Philippe [0000-0003-3485-9393]
dc.date.accessioned2022-01-28T14:40:12Z
dc.date.available2022-01-28T14:40:12Z
dc.date.issued2022-01
dc.date.submitted2021-09-27
dc.date.updated2022-01-28T14:40:11Z
dc.descriptionFunder: Global Initiative for Asthma
dc.description.abstractThe 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.
dc.identifier.doi10.17863/CAM.80445
dc.identifier.eissn1440-1843
dc.identifier.issn1323-7799
dc.identifier.otherresp14174
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/333021
dc.languageen
dc.language.isoeng
dc.publisherWiley
dc.publisher.urlhttp://dx.doi.org/10.1111/resp.14174
dc.subjectasthma
dc.subjectasthma diagnosis
dc.subjectasthma management
dc.subjectasthma prevention
dc.subjectAdministration, Inhalation
dc.subjectAdolescent
dc.subjectAdrenal Cortex Hormones
dc.subjectAdult
dc.subjectAnti-Asthmatic Agents
dc.subjectAsthma
dc.subjectChild
dc.subjectDrug Therapy, Combination
dc.subjectFormoterol Fumarate
dc.subjectHumans
dc.titleGlobal Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes.
dc.typeArticle
dcterms.dateAccepted2021-10-18
prism.endingPage35
prism.issueIdentifier1
prism.publicationNameRespirology
prism.startingPage14
prism.volume27
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1111/resp.14174

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