September 21, 2020
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.
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
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.
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.
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.
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
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 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.