Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update.


Journal

NPJ primary care respiratory medicine
ISSN: 2055-1010
Titre abrégé: NPJ Prim Care Respir Med
Pays: England
ID NLM: 101631999

Informations de publication

Date de publication:
08 02 2023
Historique:
received: 10 09 2022
accepted: 17 01 2023
entrez: 8 2 2023
pubmed: 9 2 2023
medline: 11 2 2023
Statut: epublish

Résumé

The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with "mild" asthma) as combination ICS-formoterol taken as needed for symptom relief. For patients with moderate-severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS-formoterol. Asthma treatment is not "one size fits all"; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications.

Identifiants

pubmed: 36754956
doi: 10.1038/s41533-023-00330-1
pii: 10.1038/s41533-023-00330-1
pmc: PMC9907191
doi:

Substances chimiques

Anti-Asthmatic Agents 0
Formoterol Fumarate W34SHF8J2K
Adrenal Cortex Hormones 0

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

7

Informations de copyright

© 2023. The Author(s).

Références

Levy, M. L. The national review of asthma deaths: what did we learn and what needs to change? Breathe 11, 15–24 (2015).
doi: 10.1183/20734735.008914
Royal College of Physicians. Why Asthma Still Kills. The National Review of Asthma Deaths (NRAD) Confidential Enquiry Report (RCP, 2014).
Anagnostou, K., Harrison, B., Iles, R. & Nasser, S. Risk factors for childhood asthma deaths from the UK Eastern Region Confidential Enquiry 2001–2006. Prim. Care Respir. J. 21, 71–77 (2012).
doi: 10.4104/pcrj.2011.00097
British Thoracic Association. Death from asthma in two regions of England. British Thoracic Association. Br. Med. J. 285, 1251–1255 (1982).
doi: 10.1136/bmj.285.6350.1251
Global Asthma Network. The Global Asthma Report 2022. Int. J. Tuberc. Lung Dis. 26, S1–S102 (2022).
doi: 10.5588/ijtld.22.1010
Mortimer, K., Reddel, H. K., Pitrez, P. M. & Bateman, E. D. Asthma management in low- and middle-income countries: case for change. Eur. Respir. J. 60, 2103179 (2022).
doi: 10.1183/13993003.03179-2021
Meghji, J. et al. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 397, 928–940 (2021).
doi: 10.1016/S0140-6736(21)00458-X
Stolbrink, M. et al. Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries. Int. J. Tuberc. Lung Dis. 26, 1023–1032 (2022).
doi: 10.5588/ijtld.22.0270
World Health Organization. Model List of Essential Medicines. 22nd list (2021) (WHO, 2021).
Reddel, H. K. et al. GINA 2019: a fundamental change in asthma management: treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. Eur. Respir. J. 53, 1901046 (2019).
doi: 10.1183/13993003.01046-2019
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022 (GINA, 2022).
Global Asthma Network. The Global Asthma Report 2018 (Global Asthma Network, 2018).
Aaron, S. D., Boulet, L. P., Reddel, H. K. & Gershon, A. S. Underdiagnosis and overdiagnosis of asthma. Am. J. Respir. Crit. Care Med. 198, 1012–1020 (2018).
doi: 10.1164/rccm.201804-0682CI
Aaron, S. D. et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ 179, 1121–1131 (2008).
doi: 10.1503/cmaj.081332
Lo, D. K. et al. Lung function and asthma control in school-age children managed in UK primary care: a cohort study. Thorax 75, 101–107 (2020).
doi: 10.1136/thoraxjnl-2019-213068
van Schayck, C. P., van Der Heijden, F. M., van Den Boom, G., Tirimanna, P. R. & van Herwaarden, C. L. Underdiagnosis of asthma: is the doctor or the patient to blame? The DIMCA project. Thorax 55, 562–565 (2000).
doi: 10.1136/thorax.55.7.562
Adams, R. J. et al. Underdiagnosed asthma in South Australia. Thorax 58, 846–850 (2003).
doi: 10.1136/thorax.58.10.846
Brand, P. L. et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach [European Respiratory Society Task Force]. Eur. Respir. J. 32, 1096–1110 (2008).
doi: 10.1183/09031936.00002108
Martinez, F. D. et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N. Engl. J. Med. 332, 133–138 (1995).
doi: 10.1056/NEJM199501193320301
Belgrave, D. C. M. et al. Joint modeling of parentally reported and physician-confirmed wheeze identifies children with persistent troublesome wheezing. J. Allergy Clin. Immunol. 132, 575.e2–583.e2 (2013).
doi: 10.1016/j.jaci.2013.05.041
Savenije, O. E., Kerkhof, M., Koppelman, G. H. & Postma, D. S. Predicting who will have asthma at school age among preschool children. J. Allergy Clin. Immunol. 130, 325–331 (2012).
doi: 10.1016/j.jaci.2012.05.007
Suissa, S., Ernst, P., Benayoun, S., Baltzan, M. & Cai, B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N. Engl. J. Med. 343, 332–336 (2000).
doi: 10.1056/NEJM200008033430504
Crossingham, I. et al. Combination fixed-dose beta agonist and steroid inhaler as required for adults or children with mild asthma. Cochrane Database Syst. Rev. 5, CD013518 (2021).
Price, D. B. et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J. Asthma Allergy 11, 193–204 (2018).
doi: 10.2147/JAA.S176026
Inman, M. D. & O’Byrne, P. M. The effect of regular inhaled albuterol on exercise-induced bronchoconstriction. Am. J. Respir. Crit. Care Med. 153, 65–69 (1996).
doi: 10.1164/ajrccm.153.1.8542164
Gauvreau, G. M., Jordana, M., Watson, R. M., Cockroft, D. W. & O’Byrne, P. M. Effect of regular inhaled albuterol on allergen-induced late responses and sputum eosinophils in asthmatic subjects. Am. J. Respir. Crit. Care Med. 156, 1738–1745 (1997).
doi: 10.1164/ajrccm.156.6.96-08042
Suissa, S., Blais, L. & Ernst, P. Patterns of increasing beta-agonist use and the risk of fatal or near-fatal asthma. Eur. Respir. J. 7, 1602–1609 (1994).
doi: 10.1183/09031936.94.07091602
Bloom, C. I. et al. Asthma-related health outcomes associated with short-acting β(2)-agonist inhaler use: an observational UK study as part of the SABINA Global Program. Adv. Ther. 37, 4190–4208 (2020).
doi: 10.1007/s12325-020-01444-5
Nwaru, B. I. et al. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur. Respir. J. 55, 1901872 (2020).
doi: 10.1183/13993003.01872-2019
Sobieraj, D. M. et al. Association of inhaled corticosteroids and long-acting β-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis. JAMA 319, 1485–1496 (2018).
doi: 10.1001/jama.2018.2769
Cates, C. J. & Karner, C. Combination formoterol and budesonide as maintenance and reliever therapy versus current best practice (including inhaled steroid maintenance), for chronic asthma in adults and children. Cochrane Database Syst. Rev. CD007313 (2013).
Jenkins, C. R., Bateman, E. D., Sears, M. R. & O’Byrne, P. M. What have we learnt about asthma control from trials of budesonide/formoterol as maintenance and reliever? Respirology 25, 804–815 (2020).
doi: 10.1111/resp.13804
Bisgaard, H. et al. Budesonide/formoterol maintenance plus reliever therapy: a new strategy in pediatric asthma. Chest 130, 1733–1743 (2006).
doi: 10.1378/chest.130.6.1733
Bateman, E. D. et al. Positioning as-needed budesonide-formoterol for mild asthma: effect of prestudy treatment in pooled analysis of SYGMA 1 and 2. Ann. Am. Thorac. Soc. 18, 2007–2017 (2021).
doi: 10.1513/AnnalsATS.202011-1386OC
Bateman, E. D. et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N. Engl. J. Med. 378, 1877–1887 (2018).
doi: 10.1056/NEJMoa1715275
O’Byrne, P. M. et al. Inhaled combined budesonide–formoterol as needed in mild asthma. N. Engl. J. Med. 378, 1865–1876 (2018).
doi: 10.1056/NEJMoa1715274
Beasley, R. et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N. Engl. J. Med. 380, 2020–2030 (2019).
doi: 10.1056/NEJMoa1901963
Hardy, J. et al. Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet 394, 919–928 (2019).
doi: 10.1016/S0140-6736(19)31948-8
FitzGerald, J. M. et al. Safety of as-needed budesonide-formoterol in mild asthma: data from the two phase III SYGMA studies. Drug Saf. 44, 467–478 (2021).
doi: 10.1007/s40264-020-01041-z
Reddel, H. K., Bateman, E. D., Schatz, M., Krishnan, J. A. & Cloutier, M. M. A practical guide to implementing SMART in asthma management. J. Allergy Clin. Immunol. Pract. 10, S31–s38 (2022).
doi: 10.1016/j.jaip.2021.10.011
Reddel, H. K. et al. Global Initiative for Asthma (GINA) Strategy 2021 – Executive summary and rationale for key changes. Eur. Respir. J. 59, 2102730 (2021).
Terrence Carney. Regulation 28 statement in the matter of Tamara Mills (deceased). (2015).
Dr Shirley Radcliffe. Regulation 28 Statement in the matter of Sophie Holman (deceased). (2019).
Dr Shirley Radcliffe. Regulation 28 Statement in the matter of Michael Uriely (deceased). (2017).
Chan, M. et al. Assessment of variation in care following hospital discharge for children with acute asthma. J. Asthma Allergy 14, 797–808 (2021).
doi: 10.2147/JAA.S311721
Royal College of Physicians. National Asthma and Chronic Obstructive Pulmonary Disease Audit Programme (NACAP) Children and Young People Asthma Audit 2019/20 (Royal College of Physicians, 2021).
Reddel, H. K. et al. Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study. Lancet 389, 157–166 (2017).
doi: 10.1016/S0140-6736(16)31399-X
Dusser, D. et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy 62, 591–604 (2007).
doi: 10.1111/j.1398-9995.2007.01394.x
Hekking, P. P. et al. The prevalence of severe refractory asthma. J. Allergy Clin. Immunol. 135, 896–902 (2015).
doi: 10.1016/j.jaci.2014.08.042
Bloom, C. I., Walker, S. & Quint, J. K. Inadequate specialist care referrals for high-risk asthma patients in the UK: an adult population-based cohort 2006–2017. J. Asthma 58, 19–25 (2021).
doi: 10.1080/02770903.2019.1672723
O’Neill, S. et al. The cost of treating severe refractory asthma in the UK: an economic analysis from the British Thoracic Society Difficult Asthma Registry. Thorax 70, 376–378 (2015).
doi: 10.1136/thoraxjnl-2013-204114
Sadatsafavi, M. et al. Direct health care costs associated with asthma in British Columbia. Can. Respir. J. 17, 74–80 (2010).
doi: 10.1155/2010/361071
Plaza, V. et al. Impact of patient satisfaction with his or her inhaler on adherence and asthma control. Allergy Asthma Proc. 39, 437–444 (2018).
doi: 10.2500/aap.2018.39.4183
Melani, A. S. et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir. Med. 105, 930–938 (2011).
doi: 10.1016/j.rmed.2011.01.005
Price, D. B. et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J. Allergy Clin. Immunol. Pract. 5, 1071.e9–1081.e9 (2017).
doi: 10.1016/j.jaip.2017.01.004

Auteurs

Mark L Levy (ML)

Locum General Practitioner, London, UK. mark-levy@btconnect.com.

Leonard B Bacharier (LB)

Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.

Eric Bateman (E)

Department of Medicine, University of Cape Town, Cape Town, South Africa.

Louis-Philippe Boulet (LP)

Québec Heart and Lung Institute, Université Laval, Québec City, QC, Canada.

Chris Brightling (C)

Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK.

Roland Buhl (R)

Pulmonary Department, Mainz University Hospital, Mainz, Germany.

Guy Brusselle (G)

Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Alvaro A Cruz (AA)

ProAR Foundation and Federal University of Bahia, Salvador, Bahia, Brazil.

Jeffrey M Drazen (JM)

Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA, USA.

Liesbeth Duijts (L)

Divisions of Respiratory Medicine and Allergology and Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Louise Fleming (L)

National Heart and Lung Institute, Imperial College, London, UK.

Hiromasa Inoue (H)

Department of Pulmonary Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

Fanny W S Ko (FWS)

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.

Jerry A Krishnan (JA)

Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, USA.

Kevin Mortimer (K)

Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
University of Cambridge, Cambridge, UK.
Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.

Paulo M Pitrez (PM)

Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil.

Aziz Sheikh (A)

Department of Primary Care Research & Development, Usher Institute, University of Edinburgh, Edinburgh, UK.

Arzu Yorgancıoğlu (A)

Department of Pulmonology, Celal Bayar University, Manisa, Turkey.

Helen K Reddel (HK)

The Woolcock Institute of Medical Research and The University of Sydney, Sydney, NSW, Australia.

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