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What’s new in the Global Initiative for Asthma 2018 report and beyond

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Abstract

Background

The Global Initiative for Asthma (GINA) has regularly published and annually updated a global strategy for asthma management and prevention that has formed the basis for many national guidelines. The 2018 update of the GINA report incorporates new evidence following the routine twice-yearly cumulative review of the literature by the GINA Scientific Committee.

Methods

Recommendations in the 2018 edition were examined for new content and updates, and the scientific evidence behind these recommendations was examined and discussed. Focus was given to the management of asthma in adults in the general population and children more than 5 years of age. Selected new studies related to the management of asthma that may affect future recommendations were also discussed.

Results and discussion

There have been updates in the assessment of asthma, the role of fractional exhaled nitric oxide, and the stepwise treatment of asthma. Key messages from previous versions of the guidelines were also reiterated and updated with new evidence supporting previous recommendations. Changes and new recommendations may be expected in future editions based on new scientific evidence which has emerged in the recent months.

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Abbreviations

ACO:

Asthma-chronic obstructive pulmonary disease (COPD) overlap

AMAZES:

Asthma and Macrolides: The Azithromycin Efficacy and Safety study

ATS:

American Thoracic Society

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

ERS:

European Respiratory Society

FDA:

Food and Drug Administration

FENO:

Fractional exhaled nitric oxide

FEV1:

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

GINA:

Global Initiative for Asthma

HR:

Hazard ratio

ICS:

Inhaled corticosteroid

IL-5:

Interleukin 5

LABA:

Long-acting beta agonists

LAMA:

Long-acting muscarinic antagonist

LTRA:

Leukotriene receptor antagonists

NAEPP:

National Asthma Education and Prevention Program

NNT:

Number needed to treat

OCS:

Oral corticosteroids

OR:

Odds ratio

PEF:

Peak expiratory flow

RCT:

Randomized controlled trial

SABA:

Short-acting beta agonist

TENOR:

The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens

References

  1. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2018. www.ginaasthma.org. Accessed 1 May 2018.

    Google Scholar 

  2. Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015;46:622–39.

    Article  CAS  Google Scholar 

  3. Haselkorn T, Fish JE, Zeiger RS, Szefler SJ, Miller DP, Chipps BE, et al. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol 2009;124:895–902.e1-4

    Article  Google Scholar 

  4. Ulrik CS, Frederiksen J. Mortality and markers of risk of asthma death among 1,075 outpatients with asthma. Chest. 1995;108:10–5.

    Article  CAS  Google Scholar 

  5. den Dekker HT, Sonnenschein-van der Voort AMM, de Jongste JC, Anessi-Maesano I, Arshad SH, Barros H, et al. Early growth characteristics and the risk of reduced lung function and asthma: a meta-analysis of 25,000 children. J Allergy Clin Immunol. 2016;137:1026–35.

    Article  Google Scholar 

  6. Fahy JV. Type 2 inflammation in asthma—present in most, absent in many. Nat Rev Immunol. 2015;15:57–65.

    Article  CAS  Google Scholar 

  7. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011;184:602–15.

    Article  CAS  Google Scholar 

  8. Pijnenburg MW, Hofhuis W, Hop WC, De Jongste JC. Exhaled nitric oxide predicts asthma relapse in children with clinical asthma remission. Thorax. 2005;60:215–8.

    Article  CAS  Google Scholar 

  9. Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev. 2016; https://doi.org/10.1002/14651858.CD011439.pub2.

    Article  Google Scholar 

  10. Petsky HL, Kew KM, Turner C, Chang AB. Exhaled nitric oxide levels to guide treatment for adults with asthma. Cochrane Database Syst Rev. 2016; https://doi.org/10.1002/14651858.CD011440.pub2.

    Article  Google Scholar 

  11. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343:332–6.

    Article  CAS  Google Scholar 

  12. Suissa S, Ernst P, Kezouh A. Regular use of inhaled corticosteroids and the long term prevention of hospitalisation for asthma. Thorax. 2002;57:880–4.

    Article  CAS  Google Scholar 

  13. Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV, et al. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet. 2003;361:1071–6.

    Article  CAS  Google Scholar 

  14. Cates CJ, Karner C. Combination formoterol and budesonide as maintenance and reliever therapy versus current best practice (including inhaled steroid maintenance), for chronic asthma in adults and children. Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD007313.pub3.

    Article  Google Scholar 

  15. Kew KM, Karner C, Mindus SM, Ferrara G. Combination formoterol and budesonide as maintenance and reliever therapy versus combination inhaler maintenance for chronic asthma in adults and children. Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD009019.pub2.

    Article  Google Scholar 

  16. Ducharme FM, Ni Chroinin M, Greenstone I, Lasserson TJ. Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev. 2010; https://doi.org/10.1002/14651858.CD005535.pub2.

    Article  Google Scholar 

  17. Peters SP, Bleecker ER, Canonica GW, Park YB, Ramirez R, Hollis S, et al. Serious asthma events with budesonide plus formoterol vs. budesonide alone. N Engl J Med. 2016;375:850–60.

    Article  CAS  Google Scholar 

  18. Stempel DA, Raphiou IH, Kral KM, Yeakey AM, Emmett AH, Prazma CM, et al. Serious asthma events with fluticasone plus salmeterol versus fluticasone alone. N Engl J Med. 2016;374:1822–30.

    Article  CAS  Google Scholar 

  19. Rodrigo GJ, Castro-Rodriguez JA. What is the role of tiotropium in asthma?: a systematic review with meta-analysis. Chest. 2015;147:388–96.

    Article  Google Scholar 

  20. Kew KM, Dahri K. Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2-agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma. Cochrane Database Syst Rev. 2016; https://doi.org/10.1002/14651858.CD011721.pub2.

    Article  Google Scholar 

  21. Menzella F, Lusuardi M, Galeone C, Facciolongo N, Zucchi L. The clinical profile of benralizumab in the management of severe eosinophilic asthma. Ther Adv Respir Dis. 2016;10:534–48.

    Article  CAS  Google Scholar 

  22. Nair P, Wenzel S, Rabe KF, Bourdin A, Lugogo NL, Kuna P, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376:2448–58.

    Article  CAS  Google Scholar 

  23. Richards RN. Side effects of short-term oral corticosteroids. J Cutan Med Surg. 2008;12:77–81.

    Article  CAS  Google Scholar 

  24. Kirkland SW, Vandenberghe C, Voaklander B, Nikel T, Campbell S, Rowe BH. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma. Cochrane Database Syst Rev. 2017; https://doi.org/10.1002/14651858.CD001284.pub2.

    Article  Google Scholar 

  25. Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004;59:94–9.

    Article  CAS  Google Scholar 

  26. Quon BS, Fitzgerald JM, Lemiere C, Shahidi N, Ducharme FM. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2010; https://doi.org/10.1002/14651858.CD007524.pub2.

    Article  Google Scholar 

  27. Kew KM, Quinn M, Quon BS, Ducharme FM. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2016; https://doi.org/10.1002/14651858.CD007524.pub4.

    Article  Google Scholar 

  28. Oborne J, Mortimer K, Hubbard RB, Tattersfield AE, Harrison TW. Quadrupling the dose of inhaled corticosteroid to prevent asthma exacerbations: a randomized, double-blind, placebo-controlled, parallel-group clinical trial. Am J Respir Crit Care Med. 2009;180:598–602.

    Article  CAS  Google Scholar 

  29. Reddel HK, Barnes DJ. Pharmacological strategies for self-management of asthma exacerbations. Eur Respir J. 2006;28:182–99.

    Article  CAS  Google Scholar 

  30. McKeever T, Mortimer K, Wilson A, Walker S, Brightling C, Skeggs A, et al. Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations. N Engl J Med. 2018;378:902–10.

    Article  CAS  Google Scholar 

  31. Albert RK, Connett J, Bailey WC, Casaburi R, Cooper JA Jr., Criner GJ, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365:689–98.

    Article  CAS  Google Scholar 

  32. Wong C, Jayaram L, Karalus N, Eaton T, Tong C, Hockey H, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial. Lancet. 2012;380:660–7.

    Article  CAS  Google Scholar 

  33. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the diagnosis and management of Asthma-Summary Report 2007. J Allergy Clin Immunol. 2007;120:S94–S138.

    Article  Google Scholar 

  34. Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43:343–73.

    Article  CAS  Google Scholar 

  35. Kew KM, Undela K, Kotortsi I, Ferrara G. Macrolides for chronic asthma. Cochrane Database Syst Rev. 2015; https://doi.org/10.1002/14651858.CD002997.pub4.

    Article  Google Scholar 

  36. Tong X, Guo T, Liu S, Peng S, Yan Z, Yang X, et al. Macrolide antibiotics for treatment of asthma in adults: a meta-analysis of 18 randomized controlled clinical studies. Pulm Pharmacol Ther. 2015;31:99–108.

    Article  CAS  Google Scholar 

  37. Reiter J, Demirel N, Mendy A, Gasana J, Vieira ER, Colin AA, et al. Macrolides for the long-term management of asthma—a meta-analysis of randomized clinical trials. Allergy. 2013;68:1040–9.

    Article  CAS  Google Scholar 

  38. Gibson PG, Yang IA, Upham JW, Reynolds PN, Hodge S, James AL, et al. Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial. Lancet. 2017;390:659–68.

    Article  CAS  Google Scholar 

  39. Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med. 2018;378:2486–96.

    Article  CAS  Google Scholar 

  40. Rabe KF, Nair P, Brusselle G, Maspero JF, Castro M, Sher L, et al. Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma. N Engl J Med. 2018;378:2475–85.

    Article  CAS  Google Scholar 

  41. O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, et al. Inhaled combined budesonide-formoterol as needed in mild asthma. N Engl J Med. 2018;378:1865–76.

    Article  Google Scholar 

  42. Bateman ED, Reddel HK, O’Byrne PM, Barnes PJ, Zhong N, Keen C, et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378:1877–87.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pharmacy, Singapore General Hospital, 169608, Singapore, Singapore

    Kheng Yong Ong

  2. Allergy Centre, Singapore General Hospital, Singapore, Singapore

    Kheng Yong Ong

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Correspondence to Kheng Yong Ong.

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K.Y. Ong declares that he has no competing interests.

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Ong, K.Y. What’s new in the Global Initiative for Asthma 2018 report and beyond. Allergo J Int 28, 63–72 (2019). https://doi.org/10.1007/s40629-018-0079-6

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