The Global Initiative for Asthma (GINA) today announced the release of a new Global Strategy for Asthma Management and Prevention. In a major revision of GINA’s 2002 Global Strategy, the new guidelines put the emphasis on asthma control. With appropriate treatment, most patients should be able to achieve and maintain control of all of the clinical manifestations of asthma, including symptoms, sleep disturbances, limitations of daily activity, impairment of lung function and use of rescue medications.
“The goal of asthma treatment, to achieve and maintain clinical control, can be reached in a majority of patients with a pharmacologic intervention strategy developed in partnership between the patient/family and the doctor” said Professor Paul O’Byrne, Hamilton, Ontario, Canada, Chair, GINA Executive Committee. “If we implement the management approaches described in the GINA report, there is a real chance of reducing morbidity and mortality associated with asthma.
The new report bases its asthma management strategy on three levels of control: controlled, partly controlled, or uncontrolled. This is a departure from the 2002 strategy, which was based on disease severity. By emphasizing control, the new strategy recognizes that asthma management should be based not only on the severity of the underlying disease but also on the patient’s response to treatment. Furthermore, severity is not an unvarying feature of an individual patient’s asthma but may change over months or years. The previous classification of asthma by severity into Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent is now recommended only for research purposes.
A theme continued from the 2002 report is that medications to treat asthma can be classified into controllers (medications taken daily on a long-term basis to maintain control) and relievers (used for a short time to relieve symptoms). Inhaled glucocorticosteroids are the most effective controller medications currently available. Other controller options include leukotriene modifiers and sustained release-theophylline.
Other key changes within the guidelines include:
1. Treatment should be adjusted in a continuous cycle depending on the patient’s level of control:
• Assessing asthma control
• Treating to achieve control
• Monitoring to maintain control.
2. Treatment should be stepped up when control is lost then brought back down when control is achieved.
3. Measurement of airway variability is key to both asthma diagnosis and the assessment of asthma control.
4. Effective management of asthma requires the development of a partnership between the person with asthma and his/her health care professionals (and parents/caregivers in the case of children with asthma).
5. Long-acting ß2-agonists must only be used in combination with an appropriate dose of inhaled glucocorticosteroid. Long-acting oral ß2-agonists alone are no longer presented as an option for add-on treatment at any step of therapy, unless accompanied by inhaled glucocorticosteroids.
6. Although most people with asthma should be able to reach and maintain asthma control, some patients with difficult-to-treat asthma may be unable to achieve the same level of control.
7. Special considerations are required in the diagnosis and treatment of children with asthma who are five years of age and younger.