Asthma Guidelines: The Latest From GINA

     Of significance, there is new terminology for asthma medications to provide more clarity. The terms “maintenance treatment” and “ICS-containing treatment” now replace “controller medications”. “Anti-inflammatory relievers” or “AIR” refers to inhalers like ICS-formoterol that provide quick relief while reducing inflammation. Distinguishing between using an AIR alone or as “maintenance and reliever therapy” (MART) with an ICS is key.

 GINA also added guidance on explaining the “asthma management cycle” of assessing symptoms, adjusting treatment, and reviewing the response to patients. This reminds clinicians and patients of the essential elements of good asthma control.

 The 2023 GINA guidelines provide the latest recommendations to help people effectively manage their asthma. Following these
guidelines can help reduce symptoms, prevent attacks, and maintain good lung function and quality of life. Patients should talk to their doctors about the options in the new guidelines and develop an asthma action plan tailored to their needs.

Asthma Medication Terminology Explained

 Maintenance medications, also known as ‘controllers,’ are taken regularly to control asthma symptoms and reduce inflammation in the airways. The most common are inhaled corticosteroids (ICS), which can be combined with long-acting beta agonists (LABA) for more severe asthma. ICS are considered the most effective maintenance treatment for controlling asthma.

 Relievers, such as short-acting beta agonists (SABA), provide quick relief of asthma symptoms. Common in the United States, genericalbuterol includes brand names include Ventolin and Proair. Relievers should only be used occasionally and as directed.

 Anti-inflammatory relievers (AIR) have dual purposes, reducing inflammation and relieving symptoms. Inhaled corticosteroid-formoterol (ICS-formoterol) and inhaled corticosteroid-short-acting beta agonist (ICS-SABA) inhalers can be used as both maintenance and reliever therapy for asthma. Using an AIR inhaler for both purposes is known as maintenance and reliever therapy (MART). For example, budesonide-formoterol (Symbicort) can be taken regularly to control asthma and used as needed to relieve symptoms.

 When starting or adjusting treatment, the asthma management cycle involves assessing symptoms, adjusting medications based on GINA guidelines, and reviewing response. Understanding these terms and the cycle of care can help patients better manage their asthma.

 Using the correct terminology and understanding the different types of asthma medications is key to properly managing this chronic respiratory disease. Caregivers should work closely with doctors to determine the best asthma action plans for their patients based on symptom severity and lifestyle factors. With the right approach, people of all ages can keep their asthma well-controlled and live active lives.

 Ongoing Discussion About Defining Mild Asthma

 There is ongoing discussion in the medical community about clearly defining mild asthma. The current definition is retrospective, based on a patient’s symptoms and lung function over the previous few weeks. However, doctors use the term “mild asthma” in various ways during diagnosis, education, and treatment.

 GINA continues to discuss this issue with patients, primary care physicians, and specialists. They aim to provide interim guidance for using the term “mild asthma” appropriately in different contexts. For example, during diagnosis of a new patient, a doctor may describe asthma as mild based on symptoms and initial tests. When educating health professionals, a standard definition helps ensure patients get the same quality of care.

 In studies and clinical trials, a precise definition of mild asthma is necessary to evaluate treatment effects. However, no consensus has emerged on a universal definition. Factors like symptom frequency, nighttime awakenings, medication use, and lung function all provide insight, but no single measure is definitive. A patient’s own perception of “mild” symptoms may also differ from their doctor’s assessment.

 Resolving this complex issue will require ongoing collaboration between GINA, health organizations, and the asthma community. An updated, comprehensive definition of mild asthma could help improve communication, education, and the development of tailored treatment plans for patients. Patients would also benefit from a better understanding of how doctors diagnose and categorize the severity of their asthma.

New Advice for Managing Severe Asthma

 New biologic therapies for severe asthma are providing more treatment options, especially for those with allergic or eosinophilic
inflammation. According to the updated GINA guidelines, these advanced treatments should only be considered for patients with severe asthma whose symptoms remain uncontrolled despite optimized standard treatment.

Some biologics are approved for children as young as 6 years old. However, as with any medication, the risks and benefits must be carefully considered for each patient before prescribing biologic therapy, especially in pediatrics. Close monitoring is needed to determine if treatment goals are being met and whether adjustments or alternative treatments may be needed.

For the most severe and refractory asthma cases, newer biologics targeting other inflammatory pathways may provide relief when other treatments have failed. But the high cost of these advanced biologics underscores the need for improved access to affordable, essential asthma medications worldwide. Overall, biologics have expanded options for managing severe asthma, but should only be used when standard treatments are not enough. Careful patient selection and close monitoring remains key.

 Asthma Management Cycle

 The GINA 2023 report summarizes the asthma management cycle in seven steps. First, assess the patient’s symptoms and risk factors to determine their asthma control and severity. Then, select initial treatment based on asthma severity, and provide the patient with an action plan for managing exacerbations.

 Regular follow-up is needed to monitor the patient’s symptom control and risk factors, and adjust treatment as needed. At each visit, healthcare professionals should review the patient’s symptom control and risk factors, lung function, inhaler technique, and adherence. Adjustments to treatment may involve stepping up or stepping down therapy depending on the level of symptom control.

For patients with persistent symptoms and/or exacerbations despite regular treatment, consider alternative diagnoses or triggers, as well as difficult-to-treat asthma. Adjustments may also be needed for life changes like pregnancy or older age.

The asthma management cycle aims to empower patients to achieve and maintain good symptom control, optimize their lung function and quality of life, and reduce the risk of asthma exacerbations. By routinely following this cycle, doctors and patients can work together to find and adjust treatment plans tailored to the patient’s needs. The key is to take an individualized, patient-centered approach.

 GINA continues to update asthma guidelines based on the latest research to provide the best care and management
recommendations for people living with asthma. The most recent updates cover diagnosis and management of asthma for both
children and adults. The guidelines are meant to be a helpful reference for doctors and caregivers.

 For caregivers, the guidelines highlight the importance of creating asthma action plan, ensuring proper use of inhalers and spacers, reducing asthma triggers in the home, and helping manage asthma in schools or workplaces. Patient education and open communication with doctors are key. While asthma cannot be cured, with the right treatment and management, people can live active and unrestricted lives.