Abstract
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and National Heart Lung and Blood Institute to develop a global strategy for managing and preventing asthma. GINA reports, now funded independently through the sale of GINA products, have provided the foundation for many national guidelines. They are prepared by international experts from primary, secondary and tertiary care, and are annually updated following a review of evidence. In 2014, a major revision of the GINA report was published, that took into account advances in evidence not only about asthma and its treatment, but also about how to improve implementation of evidence-based recommendations in clinical practice. This paper summarises key changes relevant to primary care in the new GINA report. A noticeable difference is the report’s radically different approach, now clinically-focussed, with multiple practical tools and flow charts to improve its utility for busy frontline clinicians. Key changes in recommendations include a new, diagnosis-centred definition of asthma; more detail about how to assess current symptom control and future risk; a comprehensive approach to tailoring treatment for individual patients; expanded indications for commencing inhaled corticosteroids; new recommendations for written asthma action plans; a new chapter on diagnosis and initial treatment of patients with asthma–COPD overlap syndrome; and a revised approach to diagnosing asthma in preschool children. The 2014 GINA report (further updated in 2015) moved away from a ‘textbook’ approach to provide clinicians with up-to-date evidence about strategies to control symptoms and minimise asthma risk, in a practical, practice-centred format.
Highlights
Asthma is a major burden worldwide, for governments, healthcare providers, patients and their carers,[1] and there is considerable variation in asthma prevalence, morbidity and mortality.[2]
The Global Initiative for Asthma (GINA) report is not a guideline, but a global strategy that can be adapted to local conditions; over the years, the reports have provided the foundation for many national guidelines
This paper summarises the key changes in the GINA strategy report that are most relevant to health professionals working in primary care
Summary
While retaining its solid evidence base, the 2014 GINA report was developed with the specific aim of improving utility for busy clinicians, with a user-friendly format, clear language and layout, and liberal use of practical summary tables and flow charts to assist with problems that clinicians face every day. Of patients with poor symptom control and/or exacerbations despite treatment, few have severe refractory (i.e., treatment-resistant) asthma;[12] the latter are estimated to comprise 5–10% of the asthma population.[13] The GINA report provides a practical algorithm that, for primary care, prioritises the investigations for the most common remediable causes of uncontrolled asthma It starts first with checking inhaler technique, as this is incorrect in up to 70–80% of patients[14] and can be corrected with appropriate skills training.[15] Confirming the diagnosis of asthma is important, npj Primary Care Respiratory Medicine (2015) 15050 as up to 25–35% of people with asthma may have been misdiagnosed;[16,17,18,19] if symptoms and lung function. It is important that asthma (or asthma– COPD overlap syndrome) should remain in the patient’s list of diagnoses, even if they develop fixed airflow limitation
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