The Woolcock Institute of Medical Research

Today the Global Initiative for Asthma (GINA) is happy to release the 2019 updates to the Pocket Guide for Asthma Management and Prevention, as well as an updated version (2.0) of the Pocket Guide on “Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients”. These important resources are now available on the GINA website www.ginasthma.org/reports 

Landmark Changes in the 2019 GINA Asthma Strategy Report

The 2019 GINA strategy report represents the most significant change in asthma management in over 30 years. The key changes in GINA 2019 are first, that for safety, GINA no longer recommends starting treatment of asthma with short-acting beta2-agonist reliever inhalers on their own. Instead, GINA recommends that all adults and adolescents with asthma should receive either symptom-driven (for mild asthma) or daily inhaled anti-inflammatory controller treatment, to reduce their risk of serious exacerbations and to control symptoms. A summary of the changes implemented in 2019, and the evidence and rationale supporting them, can be found starting on page 16 of the GINA 2019 Pocket Guide, or by downloading the “What’s new in GINA 2019?” slide set, also found at  www.ginasthma.org/reports. The full GINA 2019 report, which contains multiple practical resources for clinicians, and the 2019 online Appendix, will be available shortly. 

Prof. Helen Reddel, Chair of the GINA Science Committee and a research leader at the Woolcock Institute of Medical Research in Sydney, Australia, stated “The new GINA recommendations represent the outcome of a 12-year campaign by GINA to obtain evidence for strategies to reduce the risk of serious asthma-related exacerbations and death, including in patients with so-called mild asthma. Our aims were also to avoid establishing a pattern of patient reliance on quick-relief medications early in the course of the disease, and to facilitate consistent messaging about the goals of asthma treatment from the time of first diagnosis.” 

Summary of Changes for Severe Asthma ver2.0  

The GINA Pocket Guide on the “Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients” has proved extremely popular in both hard copy and pdf format since it was first published in November 2018. The Pocket Guide provides practical evidence-based advice for clinicians in both low and high income countries about how to assess and treat patients for whom conventional asthma therapies don’t seem to be working, and about how treatment strategies, including biologic therapies if available, can be implemented into patient care. 

The second version of this Pocket Guide includes important additions to the treatment algorithm for severe asthma, including the availability of an additional biologic treatment (dupilumab, an antibody against interleukin-4 receptor alpha), and advice about extension of a treatment trial of biologic therapy to 6-12 months if the initial response is unclear.