RN

GINA Updates Asthma Treatment Recommendations

Suzan Miller-Hoover DNP, RN, CCNS
Asthma

The Global Initiative for Asthma (GINA) was established by the World Health Organization and the National Heart Lung and Blood Institute in 1993, to increase awareness about asthma among health professionals, public health authorities and the community, and to improve asthma prevention and management through a coordinated worldwide effort (Reddel, et al., 2019).

In 2019, GINA published the first fundamental change in asthma care in 30 years.

“For safety, GINA no longer recommends treatment of asthma in adolescence and adults with short acting β2 antagonists (SABA) alone. Instead, to reduce the risk of serious exacerbations, all adults and adolescents with asthma should receive either symptom driven (in mild asthma) or daily inhaled corticosteroid-containing (ICS) treatment” (Reddel, et.al, 2019).

Implications:
  •   For over 50 years, short-acting β2 antagonists (such as albuterol) have been the first-line treatment for asthma.
     o   This is no longer safe and has been shown to lead to death
  •   For 40 years, ICS treatment has been available to asthmatics; however, adherence to maintenance treatment with ICS in mild asthma is dismal.
     o   Daily low dosing of ICS reduces hospitalization by 1/3 and results in ½ the deaths.
(Hein, 2019, & Reddel, FitzGerald, Bateman, et al., 2019)

How do ICS work?
Corticosteroids work by reducing inflammation, swelling, and mucous production in the asthma patient. Daily use of ICS results in less inflamed airways reducing trigger reactions.
  •   ICS are slow acting and may take several hours to take effect. Best results are seen after three months of daily use, but some improvement may be seen in 1-3 weeks.

ICS side-effects:
  •   Thrush (yeast infection)
  •   Hoarseness
These side-effects can be mitigated by gargling or rinsing the mouth and using a spacer device.

How does SABA work?
SABA reduce airway restriction by relaxing the airway smooth muscles, providing almost instant relief and remaining in effect for 4-6 hours.
  •   Recommended for as-needed-use only
  •   Does not reduce and may increase inflammation
  •   Black box warning

SABA side-effects:
  •   Ventricular rhythms
  •   Vasoconstriction
  •   Tachycardia
  •   Angina
  •   Muscle tremor
  •   Headache
  •   Anxiety
  •   Sleep disturbances
  •   Hyperglycemia
  •   Tolerance development

The combined efforts of the World Health Organization and the National Heart Lung and Blood Institute in 1993 established the Global Initiative for Asthma (GINA). The work of GINA has cumulated in significant changes to asthma prevention and management protocols. The most recent change occurred in 2019 when the use of short acting β2 antagonists in the treatment of adult and adolescent asthma patients became obsolete.



References
Hein, A. (2019). Big changes in asthma treatment in new global guidelines. Retrieved from: https://www.medscape.com/viewarticle/919266 Reddel, H.K., FitzGerald, J.M., Bateman, E.D., Bacharier, L.B., Becker, A…. & Boulet, L. (2019).

GINA 2019: a fundamental change in asthma management. Retrieved from: https://erj.ersjournals.com/content/53/6/1901046

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