The Saudi Initiative for Asthma - 2021 Update: Guidelines for the diagnosis and management of asthma in adults and children

Abstract

The Saudi Initiative for Asthma 2021 (SINA-2021) is the fifth version of asthma guidelines for the diagnosis and management of asthma for adults and children, which is developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5–12 years, and children aged less than 5 years. SINA guidelines have focused more on personalized approaches reflecting better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. Medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan.

Impact of Inflammation on Cytochromes P450 Activity in Pediatrics: A Systematic Review

“…Theophylline has been a commonly used drug for asthma for over 50 years, but its narrow therapeutic index has made it disappear from current asthma guidelines [79,80].…”

Saudi Arabian real-life experience with biologic therapy in severe asthma

“…Asthma can be a heterogeneous disease characterized by chronic airway limitation and airway hyperresponsiveness (AHR) with a history of recurrent classic respiratory symptoms with variable airway limitation [1,2]. Asthma is considered the most common chronic respiratory disease in Saudi Arabia, with an increase in prevalence in recent decades [3].…”

“…Severe asthma (SA) affects 3-10% of asthma patients and is associated with increased mortality, hospitalization, decreased quality of life, and higher health care costs [2]. SA is defined as "asthma that requires treatment with high-dose inhaled corticosteroids (ICS) plus a second controller (e.g., long-acting beta-2 agonist (LABA), long-acting muscarinic antagonist (LAMA), leukotriene modifier) (and/or OCS) to prevent it from becoming "uncontrolled" or that remains uncontrolled despite such therapy" [4,5].…”

“…There are different types of asthma, which we call "phenotypes". These include high and low type 2 phenotypes, which have particular implications for biological therapy [2]. Most asthma patients suffer from T2 high (eosinophilic asthma), which affects 40-70% of asthma patients.…”

“…A sputum sample of ≥2% leukocytes and a blood sample of ≥150 μl and a fractional exhaled nitric oxide (FeNO) level of ≥20 ppb are the features that respond well to ICS. It is further divided into two types: early-onset allergic eosinophilic (usually begins in childhood and is triggered by an allergen) [2,6,7] and late-onset non-allergic eosinophilic (usually begins in adulthood) airway inflammation and usually has more severe airway limitation and AHR without proven allergies [8]. T2-low (non-eosinophilic) type asthma includes neutrophilic inflammation and paucigranulocytic inflammation, and the patient is usually older, less responsive to corticosteroids, and has fewer allergic symptoms at the time of diagnosis [9,10].…”