Big Changes in Asthma Management: The 2019 GINA Report
The management of asthma has significantly evolved over the last 50 years but there have been few paradigmatic changes like those proposed in the recent 2019 Global Initiative for Asthma (GINA) report. In an effort to reduce morbidity and mortality for patients with asthma while minimizing the side effects of prescribed medications, experts came together to evaluate the newest evidence in asthma management to craft new recommendations that span the entire spectrum of asthma care for both children and adults. Among the new recommendations are significant changes to conventional maintenance regimens for patients with asthma.
The report lays out new tracks for starting and escalating controller therapy for patients both aged 6-11 years-old and 12-18 years-old based on symptom burden. These tracks include several new concepts including the use of combined inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) controllers as anti-inflammatory relievers (AIR) and the use of these combined ICS-LABA inhalers as Single Maintenance And Reliever Therapy (SMART). The report recommends that some patients may benefit from using combined ICS-LABA medications as both their controller medication and as their rescue medication instead of albuterol, depending on the severity of their asthma and their level of control. These recommendations stem from evidence that shows that patients who use albuterol alone as a rescue medication have higher rates of morbidity and mortality and that the risks of high-dose ICS controllers outweigh the benefits. A GINA 2019 Guideline Toolkit is available with supporting resources.
Here at Cincinnati Children’s we have been working on adopting these new recommendations for patients admitted with asthma exacerbations in an effort to provide care that is aligned with best evidence. Within the Division of Hospital Medicine, we are striving to increase the number of patients that are discharged on GINA guideline-concordant regimens with the hope of reducing symptom burden and reducing the number of admissions for patients with asthma. This represents a seismic cultural shift in the way we have managed asthma over the years with reduced use of albuterol and the integration of SMART for appropriate patients. We also recognize that these changes touch a vast plethora of stakeholders including providers involved in the care of patients in both the inpatient and outpatient settings. We have developed this resource that outlines the new changes and provides information on various logistics such as dosing, approved medications, and frequently asked questions. Earlier this month, these updates were discsused the 3rd Annual Joint Hospital Medicine and Community Provider education meeting. A recording of this event is available to be viewed for CME credit. The slides for the event are also available. We are committed to ongoing collaboration with all of you out in the community in order to provide the best care possible for our patients with asthma and we invite any feedback that you may have regarding these changes! You may contact Daniel.Herchline@cchmc.org or Michelle.Parker@cchmc.org.