Friday, April 12, 2019

GINA 2019 and BTS 2019

This year, we saw another major change in the GINA strategy report in asthma management.

For safety reasons, GINA no longer recommends treatment with short-acting beta2-agonist (SABA) alone. Although SABA provides quick relief of symptoms, SABA-only treatment is associated with increased risk of exacerbation and lower lung function.

On the other hand, all adults and adolescents with asthma should receive inhaled corticosteroid (ICS)-containing controller treatment. These options now include:
  • (for mild asthma) as-needed low dose ICS-formoterol, or if not available, low dose ICS taken whenever SABA is taken, or
  • regular ICS or ICS-LABA every day, plus as-needed SABA or
  • maintenance and reliever treatment with ICS-formoterol, with the reliever being low-dose budesonide-formoterol or beclomethasone dipropionate-formoterol.
However, this recommendation is not in concord with BTS/SIGN Guideline on the Maganagement of Asthma, 2019. Inhaled corticosteroids should for be considered for patients with any of the following asthma related features:
  • Asthma attack on the last two years
  • Using inhaled beta 2 agonist three times a week or more
  • Symptomatic three times a week or more
  • Waking one night a week
In short, the use of inhaled corticosteroids in all adults (including mild asthma) is debatable.

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