The GINA 2024 strategy outlines evidence-based, adaptable treatments for asthma in adults and adolescents. This article emphasises two therapy tracks for optimal care. It also highlights the importance of accessibility and proper implementation to improve global asthma outcomes.

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Approximately 300 million people worldwide suffer from asthma, which is a major global health issue that claims 1,000 lives every day. The majority of these fatalities, which are mostly avoidable, take place in low- and middle-income nations. People's ability to work, learn, and maintain a family life is hampered by asthma, particularly in youngsters.

In many economically developing nations, asthma is growing more common, and treating asthma is becoming more expensive for healthcare systems, communities, and people.

Based on the most recent research, GINA releases a strategy report each year that includes information and suggestions about asthma. Below are recently released GINA 2024 snippets.

The first part of the article deals with asthma management in adults and adolescents.

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Global asthma management: Overcoming obstacles

The difficulties that come with controlling asthma vary by area and healthcare system. Even with the availability of effective treatments and commendable efforts over the last 30 years to enhance asthma care, many people worldwide have not benefitted from advancements in asthma therapy and often do not have access to even the most basic care.

A large portion of the global population resides in regions with limited financial resources and subpar medical services. GINA understands that the suggestions in this study need to be modified to take into account regional customs and the accessibility of medical services.

Evidence-based recommendations need to be incorporated into clinical practice and health systems, as well as distributed and implemented locally and nationally, to enhance asthma treatment and patient outcomes.

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Adult and adolescent first aid for asthma

Supporting evidence underpins these suggestions.

Manifesting symptoms	First  choice therapy (Track 1)	Alternative treatment initiation (Track 2)
Infrequent asthma symptoms, e.g., 1–2 days/week or less               Asthma symptoms are less than 3–5 days/week, with normal or mildly reduced lung function	As-needed low-dose ICS- formoterol	Low-dose ICS is taken whenever SABA is taken, in combination or with separate inhalers. Such patients are highly unlikely to be adherent to daily ICS       Low-dose ICS plus as-needed SABA. Before choosing this option, consider likely adherence to daily ICS
Asthma symptoms most days (e.g., 4–5 days/week or more); or waking due to asthma once a week or more, or low lung function.	Low-dose ICS-formoterol maintenance-and-reliever therapy (MART)	Low-dose ICS-LABA plus as-needed SABA or plus as-needed ICS-SABA (Evidence B), OR Medium-dose ICS plus as-needed SABA or plus as-needed ICS-SABA Consider likely adherence with daily maintenance treatment
Daily asthma symptoms, waking. at night with asthma once a week or more, with low lung function	Medium-dose ICS-formoterol maintenance-and-reliever therapy (MART)	Medium- or high-dose ICS-LABA plus, as-needed SABA or plus as-needed ICSSABA. Consider likely adherence with daily maintenance treatment. High-dose ICS plus as-needed SABA is another option but adherence is worse than with a combination of ICS-LABA
Initial asthma presentation is during an acute exacerbation	Treat as for exacerbation, including a short course in OCS if severe; commence medium- dose MART.	Treat as for exacerbation , including a short course on OCS if severe; commence medium- or high-dose ICS-LABA plus as-needed SABA.

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Adults and adolescents: asthma treatment tracks

For clarity, two therapy tracks with treatment suggestions for adults and adolescents are presented.

Two tracks for adult and adolescent asthma therapy

1. The drug used to treat the symptoms is the main distinction. As-needed low-dose ICS formoterol is the reliever in Track 1 (recommended)
2. As-needed SABA or as-needed ICS-SABA in Track 2.

Track 1: When required, the reliever ICS at low doses: formoterol

For adults and adolescents, GINA recommends this technique as the optimal method because, as compared to regimens that employ SABA as a reliever with equivalent symptom management, low-dose ICS formoterol (an anti-inflammatory reliever; AIR) minimises the incidence of severe exacerbations.

A single medicine is used by patients for both relief and, if necessary, maintenance therapy throughout treatment, simplifying the treatment schedule.

1. Using this method, a patient may take a single inhaler of low-dose inhaled corticosteroids (ICS) to relieve their asthma symptoms at any point throughout the therapy process. This serves as their anti-inflammatory treatment in Steps 1-2.
2. As part of Steps 3–5, patients additionally take formoterol, an ICS, daily for maintenance; this combination of treatments is known as "maintenance-and-reliever therapy" (MART).

Track 2: As-needed SABA or as-needed ICS-SABA is the reliever

If Track 1 cannot be completed, or if a patient's asthma is stable, well-managed, and not exacerbating while on current medication, this is an alternate course of action.

However, take into account the patient's likelihood of adhering to their maintenance medication before prescribing a regimen with a SABA reliever, since they would be more susceptible to exacerbations otherwise.

1. Step 1 involves giving the patient a combination inhaler containing a SABA and a low-dose ICS as soon as symptoms appear, or taking the ICS right after the SABA.
2. For symptom alleviation in Steps 2-4, a SABA (alone) or ICS-SABA combination is utilised, and the patient takes an ICS-containing maintenance medicine regularly. Verify that the patient can appropriately utilise each inhaler if the relief and maintenance drugs are included in separate devices.
3. Teach the patient how to use the new inhaler if switching between stages necessitates using a different inhaler.

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Going up and down steps

1. Depending on the requirements and preferences of each patient, treatment may be shifted between tracks or moved up or down along a single track while utilising the same reliever at each stage.
2. Make sure the symptoms are caused by asthma before stepping up by looking for common issues including improper inhaler technique, poor adherence, and environmental exposures.

For further detailed information, readers are requested to go through the references.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.