JOURNAL ARTICLE | PULMONOLOGY

April 21, 2021

Global Initiative for Asthma (GINA),

What’s new in GINA 2019

Introduction

Asthma is characterized as airway hyper responsiveness and airflow obstruction at the bronchial
level. It is often reversible, either spontaneously or with treatment. It is considered a life-long
chronic airway inflammation, associated with variable structural changes, that affects both
children and adults of all ages.
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 In the Philippines, the prevalence of asthma among Filipino children has been more studied
than in adults, and has been reported in at least four previous surveys with prevalence rates
ranging from 9.2% – 27.4%.1,3,6 Currently, there are three large international studies that could
provide data on the status of asthma in adults where local prevalence can be compared. These
studies include the European Community Respiratory Health Survey (ECHRS), the World Health
Survey (WHS) and the Global Allergy and Asthma Network of Excellence (GA2LEN).4

Relevance

When poorly controlled, or uncontrolled, asthma can greatly interfere with normal activities, or
even cause untimely death. Thus, it does not only have a major impact on the individual’s quality
of life, but that of the family as well. As a public health matter, uncontrolled asthma poses as a
major economic burden.

Objectives

This technical review article aims to discuss the key changes and updates on the new GINA 2019
report which is an integrated evidence-based strategy focusing on translation into clinical
practice in the prevention of asthma deaths and exacerbations.

Highlights

The Global Initiative for Asthma (GINA) is a medical guidelines organization launched in 1993
which works with public health officials and health care professionals globally to reduce asthma
prevalence, morbidity, and mortality of asthma worldwide.2

GINA conducts continuous review of scientific publications on asthma and is at the forefront in
disseminating information about the care of patients with asthma. It publishes resources such as
evidence-based guidelines for asthma management, and runs special events such as World
Asthma Day. GINA's guidelines, revised each year, are used by clinicians worldwide.
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 The GINA report has been update this 2019 following the routine twice-yearly cumulative
review of the literature by the GINA Scientific Committee, and major work by GINA members
and other members to obtain evidences for a feasible and efficacious treatment options for
asthma.

Short acting beta agonist (SABA)-only treatment is no longer recommended for treatment of
asthma in adults and adolescents. This change was based on strong evidence that SABA-only
treatment increases the risk of severe exacerbations and asthma-related death, and that adding
any ICS significantly reduces the risk.5

GINA now recommends that all adults and adolescents with asthma should receive either
symptom-driven (in mild asthma) or daily inhaled corticosteroid (ICS)-containing controller
treatment, to reduce the risk of severe exacerbations and asthma-related death. Evidence-
based options are provided for as-needed controller treatment in mild asthma, with a preferred
controller for Step 1 and Step 2 being low dose ICS-formoterol ( a long acting beta agonist or
LABA) taken as needed for relief of symptoms and before exercise if needed. 5

ICS-formoterol and ICS are currently indicated in most countries only for maintenance
treatment or for maintenance and reliever treatment. The new recommendations for mild
asthma were made on the basis of the safety concerns about SABA-only treatment, and the
fact that ICS and ICS-LABA already have an extensive safety record, and in the case of
budesonide-formoterol, no new safety signals were seen in the large new clinical trials in mild
asthma. 5

High dose ICS-LABA treatment is now recommended only in Step 5 (previously, Step 4
treatment included moderate high dose ICS-LABA). Where possible, high ICS doses should be
prescribed for only a few months, and the potential for adverse effects should be taken into
account. 5

Conclusion

In spite of the efforts to further improve asthma care globally, many patients still have not
benefitted from the advances in asthma treatment due to the lack of basic care in the local
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 health sector. Most may not have access even to low dose ICS which is the basic controller for
attacks but with the new updates being put into practice, a clear and better understanding and
management of patients with asthma might be expected as these may provide a feasible
solution to reduce the global burden and risk of exacerbations of patients with asthma.

References

Alava HA, Dans LF, Sumpaico MW, Castor MR, De Leon JC for the 2003 NNHeS Group.
Prevalence of asthma among Filipino children 0-19 years old based on National Nutrition
and Health Survey (NNHeS). Philippine Journal of Pediatrics, 55(4): 189-195, 2006.
Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, Fitzgerald M, Gibson P, Ohta K,
O'Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ. (2008). Global
strategy for asthma management and prevention: GINA executive summary. European
Respiratory Journal. 31 (1): 143–178. doi
(https://en.wikipedia.org/wiki/Digital_object_identifier):10.1183/09031936.00138707.
PMID (https://en.wikipedia.org/wiki/PubMed_Identifier) 18166595
(https://www.ncbi.nlm.nih.gov/pubmed/18166595).
Cua-Lim F, Roa Jr. C, Ferreria M, Sumpaico M, Tuazon A, Amores J, et al. Prevalence of
asthma in Metro Manila, Philippines. Phil J AllergyImmunol. 1997; 4:9-20.
Genuneit J, Jarvis D, Flohr C. The Asthma Epidemic, Global & Time Trends of Asthma in
Adults. Global Atlas of Asthma. EAACI, 2013; pp10-13
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention,
2019. Available from: www.ginasthma.org (http://www.ginasthma.org)
Noche Jr. ML, Guno MJV, Go OC, Go BG, Andaya AG, Capulong MCT, et al. Prevalence of
childhood wheezing in Metro Manila. The Philippine Journal of Pediatrics. 1995; 44:81-7.
Pawankar R, Canonica GW, Holgate ST, Lockey RF, WAO White Book on Allergy 2011-
2012: Executive Summary, Copyright 2011 World Allergy Organization

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