Abstract
BackgroundThe 2021 Global Initiative for Asthma (GINA) report recommends as-needed inhaled corticosteroid (ICS)/formoterol irrespective of severity, and maintenance and reliever treatment (MART) from GINA Step 3 as part of Treatment Track 1, partly based on the SYGMA studies. We investigated how current clinical practice in Australia, Canada, China and the Philippines relates to latest GINA recommendations. MethodsPatients and physicians were recruited from online panels between July and August 2020 and invited to complete an online survey. Inclusion criteria: age ≥18 years, current/past physician diagnosis of asthma (patients); primary care (Canada also included respirologists/respiratory therapists), treating ≥4 patients with asthma per month, ≥3 years in clinical practice (physicians). ResultsOverall, 1216/70,183 patients and 803/8376 physicians replied and were eligible for inclusion. Only 8–15% of patients were using MART; 66–81% used regular maintenance therapy with/without an as-needed reliever. Across the four countries, physicians classified 48–63% of their patients as mild (GINA Steps 1–2) and 28–36% as moderate (GINA Steps 3–4). Generally, physicians rated symptom control over exacerbation reduction as their main treatment goal; patients also ranked symptom relief as very important. Approximately 9–29% of patients and 24–45% of physicians were unaware of MART, and among those who prescribed MART, 80–95% prescribed an additional (non-ICS) as-needed reliever. InterpretationMost physicians prioritized managing asthma symptoms over exacerbations. A lack of awareness and understanding of MART dosing exists among physicians. Practical strategies are required to implement GINA recommendations effectively in real-world clinical practice and to identify appropriate patients for MART.
Highlights
The Global Initiative for Asthma (GINA) 2021 report describes five degrees of asthma severity and suggests treatment for each of these steps [1]
13,000–23,000 invitations were sent to patients in Australia, Canada, China, and the Philippines, with approximately 300 surveys completed from each country (e-Table 1)
The high ranking of symptom relief by physicians is aligned with the control-based management approach rec ommended by the GINA report [1], which highlights that in many pa tients managed in primary care, achieving symptom control is a good guide to reduced risk of exacerbations
Summary
The Global Initiative for Asthma (GINA) 2021 report describes five degrees (steps) of asthma severity and suggests treatment for each of these steps [1]. Patients at GINA Steps 3 and 4 (moderate asthma) are described as experiencing symptoms most days and night-time awakenings once a week or more. For these patients, the preferred daily maintenance regimen is low or medium-dose ICS/formoterol as daily maintenance therapy with additional ICS/formoterol as needed (known as MART [maintenance and as-needed reliever therapy]) in Track 1; or ICS/long-acting β2-agonist (LABA) with an as-needed SABA for symptom relief in Track 2 [1]. The 2021 Global Initiative for Asthma (GINA) report recommends as-needed inhaled corticosteroid (ICS)/formoterol irrespective of severity, and maintenance and reliever treatment (MART) from GINA Step 3 as part of Treatment Track 1, partly based on the SYGMA studies.
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