As early as 1993, the National Heart, Lung, and Blood Institute (NHLBI), in cooperation with the World Health Organization (WHO), drafted a report on global asthma management and prevention strategies, and at the same time promoted the Global Initiative for Asthma (GINA), which aims to guide asthma prevention and treatment with scientific clinical evidence and has been updated yearly since 2001, providing authoritative asthma prevention and treatment guidelines for a wide range of clinicians and benefiting asthmatics around the world. benefit. Recently, the 2014 edition of the GINA guidelines (GINA2014) was released, which uses a large number of summarized tables and flow charts to give recommendations for the management of asthma patients of all ages.GINA2014 manages asthma in stages, and patients can adjust their treatment regimen in ascending and descending steps. If patients have poor symptom control after at least 2-3 months of treatment, step-up treatment can be considered; while if patients have good symptom control and maintain it for more than 3 months, and lung function has reached stability, step-down treatment can be considered. It is noteworthy that GINA2014 clearly categorizes the drugs for each stage of treatment into preferred and optional based on evidence-based medicine, providing more concise and clear guidance for clinical practice. We would like to share the interpretation of GINA2014 by Chinese and Western experts in the field of respiratory medicine with our readers. GINA2014 update points Adults, adolescents, and children aged 6-11 years with asthma step therapy (Table 1) Short-acting beta agonists (SABAs) on an as-needed basis are recommended as the preferred choice for the first stage of treatment for this group of asthma patients. ) clinical studies for use in this population are lacking, and therefore, low-dose ICS is listed as an optional medication in phase I treatment. In addition, GINA2014 states that although long-acting beta agonists (LABAs) can relieve symptoms in adults and children with asthma, irregular or frequent use of LABAs alone increases the risk of exacerbation of the patient’s condition (Level of Evidence: A). Regular use of low-dose ICS in combination with on-demand SABA is the preferred recommendation in phase II therapy. Meanwhile, leukotriene receptor antagonists (LTRA) are listed as optional due to their weaker efficacy than ICS (Level of Evidence: A). Low-dose theophylline is not recommended for children aged 6 to 11 years, due to the fact that the therapeutic dose of theophylline is close to the toxic dose, and clinical use requires great caution. The preferred recommendation for phase III therapy is the combination of low-dose ICS and LABA, along with the use of SABA or the LABA formoterol, which can be fast-acting, as needed, but is recommended for use in combination with ICS. However, a meta-analysis showed that in children with persistent asthma, low-dose ICS plus a LABA did not reduce the proportion of patients requiring systemic hormone therapy, such as oral hormone therapy, due to exacerbation, and therefore GINA2014 highlights that medium-dose ICS is also the preferred treatment recommendation for children aged 6 to 11 years. In Stage IV, the preferred recommendation for maintenance and reliever therapy for adults and adolescents with asthma is medium/high-dose ICS in combination with LABA, along with low-dose ICS in combination with formoterol or SABA, as needed. an optional treatment option is high-dose ICS in combination with LTRA. gina2014 also noted that when using medium- or high-dose budesonide, the four-times-daily dosing regimen may improve efficacy (Level of Evidence: B). During phase 5 treatment, patients should undergo a number of special tests and be considered for additional therapy. Asthma Step Therapy for Children 5 Years of Age and Younger (Table 2) On-demand use of SABA is likewise the preferred recommendation for phase I therapy in children 5 years of age and younger. However, intermittent use of ICS may be considered for children with intermittent viral-induced wheezing with asymptomatic intervals between wheezes, or for those who are not responding well to inhaled SABA.The preferred recommendation for second-stage therapy is low-dose ICS with on-demand use of SABA, and if symptomatic control is not adequate or worsening occurs at 3 months of initial treatment with low-dose ICS, a reassessment of disease, inhalation technique, and adherence to therapy should be performed assessment before considering step-up therapy. GINA2014 cites multiple studies confirming the therapeutic benefits of inhaled budesonide over placebo or the leukotriene antagonist montelukast in improving asthma symptoms, among other things, and these clinical findings solidify the therapeutic status of ICS in asthmatic children 5 years of age and younger, and furthermore, in light of the ample evidence-based medical support, GINA2014 limits the low dose of budesonide to 500μg. g. In the 2012 edition of the GINA guidelines, both ICS and LTRA were listed as optional medications of equal status, and GINA2014 made an important revision to this, with ICS defined as the preferred therapeutic agent and LTRA listed as the second choice for second-stage therapy in children 5 years of age and younger with asthma, supported by clinical evidence showing that, in young children with virally-induced asthma flare-ups, the Although LTRA was able to reduce some symptoms of persistent asthma and relapsing viral wheeze to some extent, it did not reduce hospitalization rates, courses of oral prednisone therapy, or the number of symptom-free days (Level of Evidence: A). Therefore, in preschool children with frequent viral-induced wheeze or intermittent asthma symptoms, GINA recommends that ICS be considered on an as-needed or intermittent basis. In phase III therapy, that is, in patients who are poorly controlled on low-dose ICS, the preferred regimen is double-low-dose ICS therapy; the next option is to consider the use of low-dose ICS in combination with an LTRA. If the double-low-dose ICS still does not result in good patient If double-low-dose ICS still does not result in good control of the patient’s asthma symptoms, then specialist advice and further investigations should be sought. Graded treatment of asthma in children Recently, Prof. Castro of the Catholic University of Leigh came to China to carry out academic exchanges, and the author will summarize and excerpt from Prof. Castro’s wonderful speech for the benefit of the readers. Phase II treatment ICS vs. placebo Early studies have confirmed that inhaled budesonide suspension (BIS) qd has better efficacy and safety for infants and children with persistent asthma (including inhaled hormone-dependent) compared to placebo. a meta-analysis of 29 clinical studies published by Prof. Castro in 2009 further showed that BIS, compared to placebo, was able to significantly reduce wheezing in children under 5 years of age, and that BIS was able to significantly reduce asthma in children under 5 years of age compared to placebo. significantly reduced the risk of wheezing or asthma exacerbations in children under 5 years of age (18.0% vs. 32.1%, p < 0.00001). LTRA versus placebo A recent meta-analysis conducted by Prof. Castro (results not yet published) evaluated the efficacy of LTRA in patients aged 1-6 years with viral wheeze. The main metrics assessed included (i) the number of patients requiring oral hormone therapy, (ii) the number of patients requiring hospitalization for asthma attacks, and (iii) the number of patients requiring emergency room visits for asthma attacks. The results of this analysis showed that there was no significant difference between LTRA maintenance therapy, intermittent therapy and placebo on the above indicators. ICS versus LTRA A meta-analysis published by Prof. Castro in 2010, which included 18 clinical studies and 3757 children with moderate asthma, showed that ICS significantly reduced the risk of needing systemic hormone therapy (p=0.01) and resulted in better lung function and asthma control compared to montelukast. Phase III therapy ICS versus ICS + montelukast A randomized controlled study published in 2006 compared the efficacy of inhaled budesonide 400 μg with inhaled budesonide 200 μg combined with montelukast in children with moderate persistent asthma. The results of the study showed that the proportion of asthma exacerbations was significantly lower in the budesonide 400 μg group than in the budesonide 200 μg combined with montelukast group (p < 0.01). Higher-dose ICS versus ICS+LABA A meta-analysis published by Prof. Castro in 2012 compared the efficacy of higher-dose ICS versus ICS+LABA in children/adolescents with asthma with poor symptom control. The analysis included nine clinical studies with a total of 1,641 patients. The results of the study showed that there was no significant difference in the number of patients requiring systemic hormone therapy between the two groups (p=0.25). Stage IV treatment Data from some studies have shown that the addition of omalizumab to the original treatment regimen for asthma patients aged 6 to 18 years can effectively control asthma symptoms compared with placebo. With the development of clinical studies related to asthma, evidence-based medicine in asthma, especially childhood asthma prevention and treatment is accumulating, and the goals and treatments for asthma management are becoming clearer. Against this background, GINA2014 provides a detailed description of asthma management in different age groups and gives clear treatment recommendations, from which it can be seen that the status of ICS in asthma prevention and treatment has been elevated, and ICS is the preferred recommendation for most of the treatment phases for asthma patients of all ages, and with the progress of ICS-related clinical studies, the scope of application of ICS may be further expanded in the future. GINA2014 provides an authoritative theoretical basis for the standardized management of asthma and the clinical practice of respiratory physicians in China, and we expect that its promotion and application in clinical practice will bring benefits to asthma patients in China.