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Published by Global Initiative for Asthma · Evidence levels A, B, C, D
The GINA 2019 update provides global evidence-based recommendations for the diagnosis, assessment, and management of asthma. A major update is the recommendation against short-acting beta2-agonist (SABA)-only treatment for adults and adolescents, instead recommending inhaled corticosteroid (ICS)-containing controllers to reduce the risk of severe exacerbations. The guideline also details stepwise management, management of severe asthma, pediatric asthma, and asthma-COPD overlap.
Key Takeaways
Key changes in 2019 include the fundamental shift to no longer recommend SABA-only treatment in adults and adolescents, recommending instead as-needed low dose ICS-formoterol or daily ICS. Tiotropium is now approved for ages 6+. Dupilumab is added for severe Type 2 asthma. High dose ICS-LABA is restricted to Step 5. Substantial revisions were made to the assessment and management pathways for difficult-to-treat and severe asthma.
SABA-only treatment is no longer recommended for treatment of asthma in adults and adolescents.
For patients with infrequent asthma symptoms (e.g. less than twice a month), as-needed low dose ICS-formoterol is the preferred initial controller treatment.
For patients with asthma symptoms or need for reliever twice a month or more, daily low dose ICS with as-needed SABA, or as-needed low dose ICS-formoterol are preferred controller options.
For patients with troublesome asthma symptoms most days or waking due to asthma once a week or more, low dose ICS-LABA as maintenance and reliever therapy (with ICS-formoterol) or conventional maintenance with as-needed SABA is preferred.
Low dose ICS-formoterol as maintenance and reliever therapy, or medium dose ICS-LABA maintenance plus as-needed SABA are the preferred options.
Refer for phenotypic assessment and consideration of add-on treatment, such as add-on tiotropium, azithromycin, or biologic Type 2 targeted treatments (e.g., anti-IgE, anti-IL5/5R, anti-IL4R).
At every visit, strongly encourage people with asthma who smoke to quit and provide access to counseling and smoking cessation programs.
Clinical Topic
Asthma
Objectives
To provide an evidence-based asthma management strategy for the use of health professionals and policy-makers.
Target Patient Population
Adults, adolescents, and children with asthma.
Diagnostic Criteria
History of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation.
Target Providers
Therapeutic Area
RespiratoryGuideline Scope
Care Settings
Special Populations
System: Evidence levels A, B, C, D
Evidence Levels
Contraindications
Monitoring Guidance
Assess symptom control, exacerbation risk factors, and inhaler technique at every visit. Review response 2-3 months after initiating treatment, and periodically thereafter. Step down treatment once good control is maintained for 3 months.
Difficulty
advanced
Exam Relevance
Learning Paths