Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update
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Date
2023
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Abstract
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with “mild” asthma) as combination ICS–formoterol taken as needed for symptom relief. For patients with moderate–severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS–formoterol. Asthma treatment is not “one size fits all”; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications. © 2023, The Author(s).
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Keywords
Administration, Inhalation , Adolescent , Adrenal Cortex Hormones , Adult , Anti-Asthmatic Agents , Asthma , Child , Formoterol Fumarate , Humans , Primary Health Care , beta 2 adrenergic receptor stimulating agent , corticosteroid , formoterol , short acting drug , antiasthmatic agent , corticosteroid , formoterol fumarate , adolescent , adoption , adult , age , asthma , Asthma Control Test , child , clinical outcome , combination drug therapy , control strategy , corticosteroid therapy , disease exacerbation , disease severity , futurology , global health , human , long term care , low drug dose , low income country , maintenance therapy , meta analysis (topic) , middle income country , monotherapy , patient referral , peak expiratory flow , pediatric patient , personalized medicine , practice guideline , primary care access , primary medical care , pulmonologist , Review , risk factor , risk reduction , severe asthma , spirometry , symptom , systematic review (topic) , tertiary health care , asthma , inhalational drug administration , primary health care