GINA 2019: a fundamental change in asthma management

Reddel, Helen K.; FitzGerald, J. Mark; Bateman, Eric D.; Bacharier, Leonard B.; Becker, Allan B.; Brusselle, Guy; Buhl, Roland; Cruz, Álvaro Augusto; Fleming, Louise; Inoue, Hiromasa; Ko, Fanny W.; Krishnan, Jerry A.; Levy, Mark L; Lin, Jiangtao; Pedersen, Søren; Sheikh, Aziz; Yorgancıoğlu, Arzu; Boulet, Louis‐Philippe

doi:10.1183/13993003.01046-2019

Cited by 310 publications

(154 citation statements)

References 33 publications

(38 reference statements)

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“…Accordingly, they are not included in our definition of rescue medication. Fundamental changes in clinical practice could occur in the near future, as clinical guidelines may be shifting toward recommending maintenance-and-reliever therapeutic schemes in mild to moderate patients at the expense of the traditional "SABA on demand and no maintenance" approach, and render this operational definition obsolete (Reddel et al, 2019). Fourth, despite including many relevant individual variables in our analysis, we may have omitted important variables such as the/an eosinophil count or Asthma Control Test scores as these data are not routinely recorded in linkable clinical databases, though their absence does not affect the relevance of our results.…”

Section: Limitationsmentioning

confidence: 99%

Real-World Patterns of Pharmacotherapeutic Management of Asthma Patients With Exacerbations in the Spanish National Health System

et al. 2020

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Background: Little is known about the real1world characteristics of asthma patients with exacerbations or their pharmacotherapeutic management. We described the sociodemographic and clinical characteristics, and the patterns of short and long-term management of asthma attacks, in a population-wide cohort of exacerbators in the region of Valencia, Spain. Methods: We selected asthma patients with at least one exacerbation in 2015 and 2016, we classified them according to their patterns of exacerbations in the 4 years previous to the index exacerbation and their therapeutic step at baseline based on medication received in the previous year. We described the short and long-term pharmacological management of the index exacerbation. Results: 18,714 patients experienced at least one exacerbation. The majority had no previous exacerbation (46.5%), or exacerbated in only one of the years (26.8%). 2.9% had attacks every single year, 25.7% of whom only received rescue medication at baseline. 29.5% of patients without previous exacerbation received maintenance therapy at baseline. Shortly following the index exacerbation, 2,461 patients (13.1%) did not receive any asthma prescription. Among those treated, 70.3% were prescribed a maintenance therapy, 62.4% received a rescue medication, and 30.5% received an oral corticoid. Throughout the year following the index exacerbation, most patients remained in their baseline therapeutic step. Conclusions: Most patients that exacerbate present very mild to mild forms of the disease or low levels of treatment and most exacerbations are managed in primary care. These insights may help to refine strategies for improving asthma control in the population.

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Section: Limitationsmentioning

confidence: 99%

Real-World Patterns of Pharmacotherapeutic Management of Asthma Patients With Exacerbations in the Spanish National Health System

et al. 2020

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“…short-term beta-agonists (SABA) as well as short-term muscarinic antagonists (SAMA), followed by inhaled corticosteroids (ICS), indicating patients were mainly seeking for advice in case of an exacerbation and potentially SARS-CoV-2 infection. Considering the GINA guidelines in which the authors explicitly state that asthma treatment should no longer be based solely on short-acting bronchodilators, our data clearly indicates a fail in reaching asthma patients with respective fundamental changes in therapy [9].…”

Section: To the Editormentioning

confidence: 85%

Assessing self-medication for obstructive airway disease during COVID-19 using Google Trends

et al. 2020

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“…Based on the result, healthcare professionals should identify pharmacological and nonpharmacological treatment that can improve the patients' disease control. According to GINA 2019 (1,26), personalized asthma management implies both assessing, adjusting and reviewing response of treatment. Already in 1999, the Asthma Insights and Reality in Europe (AIRE) study highlighted that asthma is dangerously under-treated in some patients (27).…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health – a report from the OLIN adult asthma cohort

et al. 2020

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Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control. Methods: In 2012-2014, n ¼ 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n ¼ 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n ¼ 830 with current asthma, n ¼ 714 answered ACT (57% women, 32-92 years) and were included in the study. Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1-3 24.1%, and treatment steps 4-5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p ¼ 0.022). Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

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GINA 2019: a fundamental change in asthma management

Cited by 310 publications

References 33 publications

Real-World Patterns of Pharmacotherapeutic Management of Asthma Patients With Exacerbations in the Spanish National Health System

Real-World Patterns of Pharmacotherapeutic Management of Asthma Patients With Exacerbations in the Spanish National Health System

Assessing self-medication for obstructive airway disease during COVID-19 using Google Trends

Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health – a report from the OLIN adult asthma cohort

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