The Global Initiative for Asthma (GINA) was developed by the World Health Organization and the Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) in collaboration with experts in the field of asthma research and prevention around the world, with the aim of increasing awareness of asthma among health workers, public health administrations, and the general public, and improving the prevention and management of asthma through joint efforts worldwide. In the 16 years since its introduction, GINA has made a significant contribution to the improvement of asthma prevention and management worldwide and has become a blueprint for asthma prevention and treatment strategies in various countries and a common guideline for clinicians in asthma management. The GINA committee also noted that the framework can be adapted to local health systems and resources.
GINA was initiated in 1993, released in 1995, and underwent two major revisions in 2002 and 2006, with the most recent revision released on January 10, 2009. 1994 to the present, important concepts such as asthma is a chronic inflammatory airway disease that requires long-term maintenance therapy; treatment should be tailored to the severity and level of control of asthma, with The main ideas of the 2009 revision of GINA regarding asthma are basically the same as the previous version.
1. Asthma is one of the most common chronic diseases, and it is estimated that 300 million people worldwide suffer from asthma. The prevalence of asthma is increasing, especially in children. However, asthma can be effectively treated and the vast majority of patients have well-controlled disease. As long as asthma is under control, people with asthma will be able to (1) be free of bothersome nighttime and daytime symptoms; (2) use little or no palliative medication; (3) enjoy a vibrant, constructive life; (4) have normal or near-normal lung function; and (5) be free from severe asthma attacks.
2, Asthma causes recurrent episodes of wheezing, shortness of breath, chest tightness and coughing, especially at night and in the early morning hours.
3.Asthma is a chronic inflammatory disease of the airways. Chronic inflammation causes increased reactivity of the airways, causing airway obstruction and airflow limitation due to bronchoconstriction, mucus plug formation and airway inflammation when the airways are exposed to various risk factors.
4. Common risk factors that trigger asthma symptoms include exposure to allergens (such as those from house dust mites, animal fur, cockroaches, pollen, and mold), occupational stimulants, smoking, respiratory (viral) infections, exercise, violent mood swings, chemical irritants, and medications (such as aspirin and beta-blockers).
5. Step-down regimens for medications designed to achieve and maintain asthma control should take into account the safety of treatment, potential adverse effects, and the cost required to achieve asthma control.
6, Acute asthma attacks (or acute exacerbations) are episodic, but airway inflammation is always present.
7. For many patients, daily use of controller medications is necessary to prevent symptoms, improve lung function, and prevent acute exacerbations. Occasional palliative medications may be required to treat acute symptoms such as wheezing, chest tightness, and cough.
8. To achieve and maintain asthma control, a partnership between the asthma patient and his or her medical team is needed.
9. There should be no shame in asthma. People with asthma include Olympic athletes, well-known leaders and other prominent individuals, and ordinary people can have successful lives just like them.
At the same time, the successive revisions of GINA reflect not only the in-depth research on the pathogenesis of asthma, but also, and more importantly, the continuous updating of the concepts and means of asthma treatment and management based on evidence-based medicine provided by multicenter randomized controlled clinical trials. 2006 saw the largest update of GINA, which for the first time proposed a treatment strategy based on the level of asthma control, while substantially reducing the basic research The main content of the 2009 revision of GINA is basically the same as the 2006 revision, with the updated section referring to the literature from July 1, 2008 to June 31, 2009, of which 402 papers were included in the analysis and 23 papers prompted the GINA committee to revise the relevant content. In addition, another important change to the 2009 GINA is that the Global Strategy for the Prevention and Management of Asthma in Children 5 Years and Younger was issued in early 2009 as a separate edition.
Key changes in the 2009 GINA revision include.
1. providing, to the greatest extent possible, a well-defined and user-friendly document for busy clinicians, especially those in primary care, as well as providing up-to-date references for easy access by readers
2. Greater emphasis on asthma control throughout the document. Strong evidence suggests that clinical manifestations of asthma such as symptoms, sleep disturbances, activity limitation, decreased lung function, and use of relieving medications can be controlled with appropriate treatment.
3. Epidemiological data were updated, particularly from the Global Burden of Asthma Report. These data show that although the cost of controlling asthma is high from the patient’s and society’s point of view, the cost associated with incorrectly treated asthma is even higher.
4. The concept of refractory asthma was further proposed and developed. Patients with refractory asthma are often relatively insensitive to glucocorticoids and sometimes fail to achieve the same level of control as other patients.
5. Pulmonary function measured by lung flow meters and peak flow velocimetry is still recommended as an adjunct to asthma diagnosis and monitoring. Special emphasis is placed on monitoring the variability of airflow limitation, which is key to asthma diagnosis and assessment of asthma control.
6. Previous asthma severity grading recommendations were used for asthma research purposes only.
7. Current guidelines recommend classification according to the level of asthma control: controlled, partially controlled and uncontrolled. This reflects the fact that asthma severity not only encompasses the severity of the disease itself, but also reflects responsiveness to treatment, and that the severity of a particular asthma patient is not static, but is in flux from month to month and year to year.
The emphasis throughout the report remains on the goal of asthma treatment to obtain and maintain asthma control.
8. Emphasis was placed on the notion that increased use of relieving medications, particularly the need for daily use, signals worsening asthma control and the need to reassess treatment. Building on GINA 2006, GINA 2009 further suggests that assessment of the level of asthma control should include control of clinical symptoms of asthma and control of anticipated future risks, such as acute exacerbations, accelerated lung decompensation, and side effects of therapy. In general, achieving control of asthma reduces the risk of acute exacerbations. Assessment of future risks includes the risk of acute exacerbations, instability, rapid decompensation of lung function, and medication side effects. Characteristics associated with increased risk of future adverse events include: poor clinical control, frequent acute exacerbations in the past year or even the need for medical assistance, lower FEV1, exposure to smoking, and use of high doses of medications.
9. The status of several medications in the treatment of asthma was re-evaluated.
Recent data suggest a possible association between LABA use and increased risk of asthma-related death in a small population, and therefore GINA 2009 specifically emphasizes that LABAs should not be used alone in the treatment of asthma, but in combination with appropriate doses of ICS.
Leukotriene modulators are becoming more important in the management of asthma, especially in adults. Oral LABA is no longer recommended as an add-on drug of choice at any therapeutic level, unless used in conjunction with ICS.
In adults, sodium cromoglycate alone is no longer recommended as an alternative treatment to low-dose ICS.
Adjustments have been made to certain ICS daily equivalent doses.
The original appendices were A: Controlled Medications, Appendix B: Symptom Relief Medications. 2009 GINA appendices are A: Controlled Medications, Appendix B: Asthma Combination Medications, and Appendix C Symptom Relief Medications. Appendix C lists not only fluticasone propionate/salmeterol dry powder (sulforaphane) and budesonide/formoterol dry powder (Cymbalta) marketed in China, but also other countries/regions using fluticasone propionate/salmeterol aerosol and budesonide/formoterol aerosol, as well as beclomethasone/formoterol aerosol.
10. Adjusted the 6 sections of the previous version of asthma management to 5 sections.
Establishing a physician-patient partnership
Identifying risk factors and reducing exposure
Assessing, treating, and monitoring asthma
Managing acute asthma attacks
Special problems of asthma
11. Part I emphasizes that effective asthma management requires building a partnership between the asthma patient and his or her physician. This partnership can be established and strengthened by physicians and patients discussing and agreeing on goals for asthma treatment, developing a written, individualized asthma action plan, and reviewing the patient’s level of treatment and control at regular follow-up visits. Education remains at the core of the doctor-patient relationship.
12, Part III presents the overall concept of a management program around asthma control. Treatment initiation and adjustment is a continuous cycle driven by asthma control.
13, Treatment options are divided into 5 levels or steps (steps) that reflect the intensity of treatment (dose or/and type of medication) needed to control asthma. For all treatment steps, palliative medications should only be used as needed. From step 2 to step 5, controller medications are required.
14. If the current treatment regimen does not control asthma, it should be escalated until asthma is controlled. When asthma control is maintained, treatment should be downgraded to find the lowest therapeutic level and dose to maintain control.
15. Although the above 5 sections contain recommendations for asthma patients of all ages, advice should be provided with caution for children with asthma aged 5 years and younger. For this group of patients, the expert committee has developed a separate document.
16. A large body of evidence suggests that the prognosis of asthma patients can be improved when managed according to evidence-based medicine norms for asthma under different conditions in different regions. Such evidence-based norms should be promoted and implemented at the national and local levels.