The Global Initiative for Asthma (GINA) has released a 2019 update to their Pocket Guide for Asthma Management and Prevention and the Pocket Guide on Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients.
The key changes are:
- For safety, GINA no longer recommends starting treatment of asthma with short-acting beta2-agonist (SABA) reliever inhalers on their own. Instead all adults and adolescents with asthma should receive either symptom-driven (for mild asthma) or daily inhaled anti-inflammatory controller treatment, to reduce their risk of serious exacerbations and to control symptoms.
- The updated recommendations for severe asthma include additions to the treatment algorithm for severe asthma, including the availability of an additional biologic treatment (dupilumab, an antibody against interleukin-4 receptor alpha), and advice about extension of a treatment trial of biologic therapy to 6-12 months if the initial response is unclear.
PCRS Executive Chair Dr Noel Baxter says: “This is a helpful review of the latest evidence. The GINA recommendation that the first step for treating asthma is to treat inflammation is not dissimilar to the BTS/SIGN position which PCRS supports.
“However it is important to remember that SABA does still have important value in COPD and in emergency therapy