Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update
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 cl...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2023-02-01
|
| Series: | npj Primary Care Respiratory Medicine |
| Online Access: | https://doi.org/10.1038/s41533-023-00330-1 |
| _version_ | 1811166088873902080 |
|---|---|
| author | Mark L. Levy Leonard B. Bacharier Eric Bateman Louis-Philippe Boulet Chris Brightling Roland Buhl Guy Brusselle Alvaro A. Cruz Jeffrey M. Drazen Liesbeth Duijts Louise Fleming Hiromasa Inoue Fanny W. S. Ko Jerry A. Krishnan Kevin Mortimer Paulo M. Pitrez Aziz Sheikh Arzu Yorgancıoğlu Helen K. Reddel |
| author_facet | Mark L. Levy Leonard B. Bacharier Eric Bateman Louis-Philippe Boulet Chris Brightling Roland Buhl Guy Brusselle Alvaro A. Cruz Jeffrey M. Drazen Liesbeth Duijts Louise Fleming Hiromasa Inoue Fanny W. S. Ko Jerry A. Krishnan Kevin Mortimer Paulo M. Pitrez Aziz Sheikh Arzu Yorgancıoğlu Helen K. Reddel |
| author_sort | Mark L. Levy |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-10T15:46:52Z |
| format | Article |
| id | doaj.art-dd505e9d9081431bb9d495ee006b72e6 |
| institution | Directory Open Access Journal |
| issn | 2055-1010 |
| language | English |
| last_indexed | 2024-04-10T15:46:52Z |
| publishDate | 2023-02-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Primary Care Respiratory Medicine |
| spelling | doaj.art-dd505e9d9081431bb9d495ee006b72e62023-02-12T12:04:55ZengNature Portfolionpj Primary Care Respiratory Medicine2055-10102023-02-0133111310.1038/s41533-023-00330-1Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) updateMark L. Levy0Leonard B. Bacharier1Eric Bateman2Louis-Philippe Boulet3Chris Brightling4Roland Buhl5Guy Brusselle6Alvaro A. Cruz7Jeffrey M. Drazen8Liesbeth Duijts9Louise Fleming10Hiromasa Inoue11Fanny W. S. Ko12Jerry A. Krishnan13Kevin Mortimer14Paulo M. Pitrez15Aziz Sheikh16Arzu Yorgancıoğlu17Helen K. Reddel18Locum General PractitionerDepartment of Pediatrics, Vanderbilt University Medical CenterDepartment of Medicine, University of Cape TownQuébec Heart and Lung Institute, Université LavalInstitute for Lung Health, Leicester NIHR BRC, University of LeicesterPulmonary Department, Mainz University HospitalDepartment of Respiratory Medicine, Ghent University HospitalProAR Foundation and Federal University of BahiaBrigham and Women’s Hospital and Department of Medicine, Harvard Medical SchoolDivisions of Respiratory Medicine and Allergology and Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center RotterdamNational Heart and Lung Institute, Imperial CollegeDepartment of Pulmonary Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Medicine and Therapeutics, The Chinese University of Hong KongBreathe Chicago Center, University of Illinois ChicagoLiverpool University Hospitals NHS Foundation TrustHospital Santa Casa de Porto AlegreDepartment of Primary Care Research & Development, Usher Institute, University of EdinburghDepartment of Pulmonology, Celal Bayar UniversityThe Woolcock Institute of Medical Research and The University of SydneyAbstract 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.https://doi.org/10.1038/s41533-023-00330-1 |
| spellingShingle | Mark L. Levy Leonard B. Bacharier Eric Bateman Louis-Philippe Boulet Chris Brightling Roland Buhl Guy Brusselle Alvaro A. Cruz Jeffrey M. Drazen Liesbeth Duijts Louise Fleming Hiromasa Inoue Fanny W. S. Ko Jerry A. Krishnan Kevin Mortimer Paulo M. Pitrez Aziz Sheikh Arzu Yorgancıoğlu Helen K. Reddel Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update npj Primary Care Respiratory Medicine |
| title | Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update |
| title_full | Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update |
| title_fullStr | Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update |
| title_full_unstemmed | Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update |
| title_short | Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update |
| title_sort | key recommendations for primary care from the 2022 global initiative for asthma gina update |
| url | https://doi.org/10.1038/s41533-023-00330-1 |
| work_keys_str_mv | AT markllevy keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT leonardbbacharier keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT ericbateman keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT louisphilippeboulet keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT chrisbrightling keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT rolandbuhl keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT guybrusselle keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT alvaroacruz keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT jeffreymdrazen keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT liesbethduijts keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT louisefleming keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT hiromasainoue keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT fannywsko keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT jerryakrishnan keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT kevinmortimer keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT paulompitrez keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT azizsheikh keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT arzuyorgancıoglu keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate AT helenkreddel keyrecommendationsforprimarycarefromthe2022globalinitiativeforasthmaginaupdate |