The Global Initiative For Asthma (GINA) Announces Major Changes In Its Guidance For Asthma Management And Prevention

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 B2-agonists must only be used in combination with an appropriate dose of inhaled glucocorticosteroid. Long-acting oral B2-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.

Professor Eric Bateman, Cape Town, South Africa, Chair of the GINA Science Committee urged general practitioners and other healthcare professionals to read and implement the new guidelines. "Only by understanding and applying these guidelines can our goal of truly controlling asthma be reached and maintained," he said.

Asthma is a major public health concern and according to current estimates, 300 million people are affected worldwide. In children, asthma is the most common chronic disease. Asthma is an inflammatory disorder of the airways with symptoms that include recurrent episodes of wheezing, coughing, breathlessness and chest tightness. If asthma is controlled with appropriate treatment, flare-ups and exacerbations should be minimized.

Copies of the new guidelines are being distributed to healthcare professionals across the globe this week. An online version will be available on the GINA website, http://www.ginasthma.org.

About GINA

GINA was formed in 1993 to work with healthcare professionals and public health officials around the world to reduce asthma prevalence, morbidity, and mortality. GINA consists of a network of individuals and organisations interested in asthma care, working together to design, implement and evaluate asthma care programs to meet local needs. For more information relating to the work of GINA, please contact them at http://www.ginasthma.org.