GINA 2024: Key Updates to optimise asthma care standards

The Global Initiative for Asthma (GINA) has released its 2024 update on asthma management and prevention. This report, authored by the GINA Science Committee, brings significant updates on various topics crucial for effective asthma management. These include diagnosing asthma, managing cough variant asthma, assessing asthma control, setting treatment goals, achieving asthma remission and providing initial treatment recommendations for adults, adolescents and children. Additionally, there are updated medication recommendations and a revised section on allergen immunotherapy. This comprehensive guidance is designed for primary care practitioners, specialists and other healthcare professionals involved in asthma care.

The latest updates provide significant insights into managing various asthma conditions. For patients with cough variant asthma, despite often normal spirometry results, airway hyper-responsiveness is typically observed along with sputum eosinophilia and increased FeNO levels. Standard asthma treatment protocols are recommended for these patients.

Ongoing monitoring is crucial, with GINA advising that symptom control over the previous four weeks should be assessed and risk factors for exacerbations and persistent airflow limitations identified. Lung function should be measured at diagnosis, three to six months after starting ICS therapy, and periodically thereafter. Risk factors include SABA overuse, inadequate ICS, smoking, air pollution, psychosocial factors and type 2 inflammatory markers. Regular inquiries about asthma symptoms, night waking, activity limitation and SABA use are essential for comprehensive monitoring.

The primary goal of asthma treatment is to achieve optimal patient outcomes, including symptom control and minimizing exacerbation risks. This involves considering patients’ personal goals alongside medical objectives. Predictors of asthma remission in children include fewer and milder episodes, good lung function, and less airway hyper-responsiveness. In adults, predictors include improved symptom control with biologic therapy, good lung function, fewer comorbidities, and minimal or no OCS use.

For initial asthma treatment in adults and adolescents, the report provides an update on the preferred treatments. Track 1 now recommends as-needed low-dose ICS-formoterol for steps 1 and 2, and medium-dose ICS-formoterol MART for step 4. Track 2 suggests ICS with SABA as needed. Additional guidance covers AIR therapy, medication doses, and the use of LAMAs for uncontrolled asthma.

Treatment re-evaluation for severe asthma patients responding well to type 2 therapy should occur every three to six months, with a focus on reducing OCS use. Stepping down treatment can be considered for well-controlled asthma, ensuring patient engagement, proper documentation and clear action plans.

For children aged 6 to 11, initial treatment recommendations align with those for adults and adolescents. Low-dose ICS with SABA is recommended for infrequent symptoms, while medium-dose ICS-LABA is advised for more frequent symptoms. During an acute exacerbation, initial treatment should include OCS if necessary.

In terms of allergen immunotherapy, GINA recommends weighing the benefits against the risks and costs of SCIT and SLIT. SCIT should begin only when asthma is well controlled. HDM SLIT may be considered for adults and adolescents with persistent symptoms despite ICS treatment and for children sensitized to ragweed during the season.

In the report, GINA has also updated its diagnostic flowchart for adults, adolescents, and children aged 6 to 11 years with chronic or recurrent respiratory symptoms. The flowchart includes guidelines for using peak expiratory flow (PEF) to diagnose asthma, acknowledging that many healthcare providers lack access to spirometry. GINA recommends using the best of three PEF measurements with the same meter for follow-up due to potential variations between meters. The update advises documenting evidence of asthma before starting inhaled corticosteroid (ICS) treatment. Additionally, mild asthma is now seen as a retrospective label, and structured outpatient pulmonary rehabilitation programs are endorsed for improving functional exercise capacity and quality of life. A new section addresses preventing occupational asthma, noting that 5% to 20% of adult-onset asthma cases may be job-related, and advises referring affected patients for expert assessment.

The full 2024 GINA report is available here and summarised here.

Disclosures: This article was created by the touchRESPIRATORY team utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No funding was received in the publication of this article.