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Pruebas previas, online el 30 de Octubre de 2021
Global Initiative for Asthma (GINA) Strategy 2021 – Executive summary and rationale for key changes
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Helen K. Reddel1,
Autor para correspondencia
helen.reddel@sydney.edu.au

Corresponding author:
, Leonard B. Bacharier2, Eric D. Bateman3, Christopher E. Brightling4, Guy Brusselle5, Roland Buhl6, Alvaro A. Cruz7, Liesbeth Duijts8, Jeffrey M. Drazen9, J. Mark FitzGerald10, Louise J. Fleming11, Hiromasa Inoue12, Fanny W. Ko13, Jerry A. Krishnan14, Mark L. Levy15, Jiangtao Lin16, Kevin Mortimer17, Paulo M. Pitrez18, Aziz Sheikh19, Arzu A. Yorgancioglu20, Louis-Philippe Boulet21
1 The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
2 Monroe Carell Jr Children’s Hospital at Vanderbilt University Medical Center, Nashville, TN, USA
3 Department of Medicine, University of Cape Town, Cape Town, South Africa
4 Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
5 Ghent University Hospital, Ghent, Belgium and Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
6 Pulmonary Department, Mainz University Hospital, Mainz, Germany
7 Federal University of Bahia, Salvador, BA, Brazil
8 Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
9 Brigham and Woman’s Hospital and Harvard Medical School, Boston, MA, USA
10 University of British Columbia, Vancouver, BC, Canada
11 Imperial College, London, United Kingdom
12 Kagoshima University, Kagoshima, Japan
13 The Chinese University of Hong Kong, Hong Kong
14 Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, USA
15 Locum GP, London, UK
16 China-Japan Friendship Hospital, Peking University, Beijing, China
17 Liverpool School of Tropical Medicine, Liverpool, UK
18 Hospital Moinhos de Vento, Porto Alegre, Brazil
19 Usher Institute, The University of Edinburgh, United Kingdom
20 Celal Bayar University, Department of Pulmonology, Manisa, Turkey
21 Québec Heart and Lung Institute, Université Laval, Québec, QC, Canada
Información del artículo
Abstract

The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes.

GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting beta2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as- needed combination ICS-formoterol reduces severe exacerbations by ≥60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function and inflammatory outcomes as daily ICS plus as-needed SABA.

Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as-needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, MART) in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting beta2-agonist (LABA) (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4

Across all age-groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment and review remain essential to optimize asthma outcomes.

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