Global Initiative for AsthmaPulmonology2026advanced

Global Strategy for Asthma Management and Prevention

Published by Global Initiative for Asthma · Levels of Evidence A, B, C, D

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Summary

AI-generated

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It imposes a massive global health burden. The GINA Strategy Report provides an evidence-based approach to the diagnosis, assessment, and personalized management of asthma to achieve long-term symptom control, minimize exacerbation risks, and reduce asthma mortality.

asthmaGINA2026pulmonologyICS-formoterolSABAoral corticosteroidsguidelines

Key Takeaways

1
SABA-only treatment is no longer recommended; ICS-containing treatment is essential to reduce the risk of severe exacerbations and death.
2
GINA Track 1 with low-dose ICS-formoterol as an anti-inflammatory reliever (AIR) is the preferred treatment approach for adults and adolescents.
3
GINA Track 2 now includes anti-inflammatory reliever (AIR) therapy with combination ICS-SABA added at Step 1.
4
Confirmation of the asthma diagnosis through objective lung function testing is critical to avoid over- or under-treatment.
5
Asthma control involves assessing both recent symptom control and the future risk of adverse outcomes like exacerbations.
6
Difficult-to-treat and severe asthma require systematic evaluation of inhaler technique, adherence, comorbidities, and phenotypic markers before stepping up to biologic therapies.
7
OCS stewardship is prioritized to minimize the short-term and long-term adverse effects of oral corticosteroids.

What's New in This Version

Key changes in the GINA 2026 Strategy Report include the development of four new flowcharts for the management of acute asthma in primary care and acute care facilities. GINA Track 2 has been updated to include anti-inflammatory reliever (AIR) therapy with combination ICS-SABA at Step 1. New assessment tools, such as the Chronic Airways Assessment Test (CAAT) and the Pediatric Asthma Impairment and Risk Questionnaire (Peds-AIRQ), have been introduced. Additionally, instructions for AIR and MART doses have been simplified, and updated guidance is provided on OCS stewardship, long-acting muscarinic antagonists (LAMAs), and vaccinations (including RSV).

Key Recommendations

Medications and treatment regimens

REC-1
For safety, GINA does not recommend treatment of asthma in adults, adolescents or children 6–11 years with short-acting beta2-agonist (SABA) alone. Instead, they should receive inhaled corticosteroid (ICS)-containing treatment to reduce their risk of severe exacerbations and to control symptoms.
Evidence: ATreatment
REC-2
Track 1 (preferred): using low-dose ICS-formoterol as an anti-inflammatory reliever (AIR) is the preferred approach recommended by GINA for adults and adolescents with asthma, because it reduces the risk of severe exacerbations compared with regimens that use SABA as reliever.
StrongEvidence: ATreatment

Non-pharmacological strategies

REC-3
Allergen avoidance is not recommended as a general strategy for people with asthma.
Evidence: AManagement
REC-4
Aspirin and NSAIDs are not generally contraindicated in asthma unless there is a history of previous reactions to these agents.
Evidence: AManagement

Diagnosis

REC-5
Lung function measurement using spirometry (peak flow if spirometry is not available) is strongly recommended for all patients (except preschool children, or life-threatening presentations) presenting with acute asthma, and again before discharge.
StrongDiagnosis/Assessment

Scope & Objectives

Clinical Topic

Asthma Management and Prevention

Objectives

To reduce asthma prevalence, morbidity, and mortality through an evidence-based asthma management strategy for healthcare providers and policy-makers.

Target Patient Population

Adults, adolescents, and children with asthma.

Diagnostic Criteria

History of typical variable respiratory symptoms (wheeze, shortness of breath, chest tightness, cough) combined with confirmed excessive variability in expiratory lung function (e.g., FEV1 or PEF).

Target Providers

Healthcare providersPrimary care practitionersSpecialistsAllied health professionalsPolicy-makers

Patient Criteria & Setting

Therapeutic Area

Respiratory

Guideline Scope

DiagnosisAssessmentManagementPrevention

Care Settings

Primary careSpecialist careEmergency departmentAcute care facility

Special Populations

Children 5 years and youngerChildren 6-11 yearsAdolescentsAdultsPregnant womenOlder adultsObese patientsPatients with occupational asthmaPatients with aspirin-exacerbated respiratory disease (AERD)

Evidence Grading

System: Levels of Evidence A, B, C, D

Evidence Levels

ARandomized controlled trials (RCTs), systematic reviews, observational evidence. Rich body of data. Evidence is from endpoints of well-designed RCTs, systematic reviews of relevant studies or observational studies that provide a consistent pattern of findings in the population for which the recommendation is made.

BRandomized controlled trials and systematic reviews. Limited body of data. Evidence is from endpoints of intervention studies that include only a limited number of patients, post hoc or subgroup analysis of RCTs or systematic reviews of such RCTs.

CNonrandomized trials or observational studies. Evidence is from non-randomized trials or observational studies without consistent findings.

DPanel consensus judgment. Used only in cases where the provision of some guidance was deemed valuable but the clinical literature addressing the subject was insufficient to justify placement in one of the other categories.

Safety & Contraindications

Contraindications

Regular maintenance use of SABA without ICS
Aspirin and NSAIDs in patients with a history of previous reactions (AERD)

Monitoring Guidance

Assess asthma symptom control using validated tools (e.g., ACT, ACQ), lung function, exacerbation history, medication side effects, inhaler technique, and adherence. Adjust treatment in a step-wise approach and schedule regular follow-ups (e.g., 1-3 months after starting treatment and within 2-7 days after an exacerbation).

Guideline Features

Dosing informationFlowcharts includedBased on systematic reviewMultidisciplinaryPatient involvementDrug interactions discussed

Learning Context

Difficulty

advanced

Learning Paths

Asthma ManagementPulmonologyRespiratory CareSevere AsthmaAsthma ExacerbationsBiologic TherapiesPrimary Care