scholarly journals Global Initiative for Asthma (GINA) Strategy 2021 – Executive summary and rationale for key changes

2021 ◽  
Author(s):  
Helen K. Reddel ◽  
Leonard B. Bacharier ◽  
Eric D. Bateman ◽  
Christopher E. Brightling ◽  
Guy G. Brusselle ◽  
...  
Keyword(s):  
Executive Summary ◽  
Global Initiative For Asthma ◽  
Global Initiative

scholarly journals Global Initiative for Asthma (GINA) Strategy 2021 - Executive summary and rationale for key changes

2021 ◽  
pp. 2102730
Author(s):  
Helen K. Reddel ◽  
Leonard B. Bacharier ◽  
Eric D. Bateman ◽  
Christopher E. Brightling ◽  
Guy G. Brusselle ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Age Groups ◽  
Skills Training ◽  
Mild Asthma ◽  
Executive Summary ◽  
Global Initiative For Asthma ◽  
Global Initiative ◽  
Long Acting ◽  
Beta2 Agonist

The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes.GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting beta2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as- needed combination ICS-formoterol reduces severe exacerbations by >60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function and inflammatory outcomes as daily ICS plus as-needed SABA.Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as-needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, MART) in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting beta2-agonist (LABA) (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11  years, new treatment options are added at Steps 3-4.Across all age-groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment and review remain essential to optimize asthma outcomes.

scholarly journals Global Initiative for Asthma (GINA) Strategy 2021 – Executive summary and rationale for key changes

2021 ◽  
Author(s):  
Helen K. Reddel ◽  
Leonard B. Bacharier ◽  
Eric D. Bateman ◽  
Christopher E. Brightling ◽  
Guy Brusselle ◽  
...  
Keyword(s):  
Executive Summary ◽  
Global Initiative For Asthma ◽  
Global Initiative

scholarly journals Global Initiative for Asthma (GINA) Strategy 2021 – Executive Summary and Rationale for Key Changes

2021 ◽  
Author(s):  
Helen K Reddel ◽  
Leonard B Bacharier ◽  
Eric D Bateman ◽  
Christopher E. Brightling ◽  
Guy G. Brusselle ◽  
...  
Keyword(s):  
Executive Summary ◽  
Global Initiative For Asthma ◽  
Global Initiative

scholarly journals Depression Levels Influence the Rate of Asthma Exacerbations in Females

2021 ◽  
Vol 11 (6) ◽  
pp. 586
Author(s):  
Papaporfyriou Anastasia ◽  
Tseliou Eleni ◽  
Mizi Eleftheria ◽  
Ntontsi Xenia ◽  
Papathanasiou Eygenia ◽  
...  
Keyword(s):  
Control Level ◽  
Depression Scale ◽  
Low Frequency ◽  
Anxiety And Depression ◽  
Asthmatic Patients ◽  
Asthma Exacerbations ◽  
Depression Subscale ◽  
Global Initiative For Asthma ◽  
Asthma Patients ◽  
Global Initiative

Background: Anxiety and depression are common psychological disturbances among asthmatic patients. The aim of the present study is the assessment of anxiety and depression in asthmatic patients and their correlation with symptoms control level and number of exacerbations per year. Methods: One hundred patients with asthma diagnosis, according to the Global Initiative for Asthma (GINA), aged > 18 years old, having a stable disease, were included. Emotional status was evaluated using the Hospital Anxiety Depression Scale (HADS). Patients were followed up for a year to assess the number and severity of exacerbations. Results: Most of our patients were female (58%), middle-aged (mean = 54 ± 13), and married (81%), with low frequency of smoking habits (smokers, ex-smokers and non-smokers were 26%, 30% and 37%, respectively) and low levels of both anxiety and depression [median (interquartile range (IQR)) = 4(2) and median (IQR) = 4(2), respectively]. At the low and moderate level of the depression subscale, female patients experienced asthma exacerbations more frequently compared to male patients (adjusted Incidence Rate Ratio (aIRR) = 4.30; 95% Confidence Interval (CI): 1.94–9.53 and aIRR = 1.82; 95% CI: 1.07–3.13, respectively). Conclusions. Clinicians should evaluate asthma patients for depression, as gender differentially influences outcomes among those with low and moderate levels of depression, with female asthmatics presenting more frequent exacerbations.

The relationship between BMI, leptin, leptin receptors (LepR) and Foxp3+ Tregs cells in women with asthma

2016 ◽  
Vol 51 (4) ◽  
pp. 277-284
Author(s):  
Łukasz Kraszula ◽  
Makandjou-Ola Eusebio ◽  
Anna Jasińska ◽  
Maciej Kupczyk ◽  
Piotr Kuna ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Leptin Receptor ◽  
Control Group ◽  
Soluble Receptor ◽  
Leptin Receptors ◽  
Global Initiative For Asthma ◽  
Moderate Disease ◽  
Global Initiative ◽  
And Control ◽  
The Relationship

The aim of this study was evaluation whether there is an association between BMI, leptin and its soluble receptor, the expression of FoxP3 in CD4+ pTreg in women with severe asthma. Materials and methods. The study included thirty women with asthma: 17 patients with severe and 13 with mild-moderate disease. The control group comprised of 25 healthy women. Asthma was diagnosed in accordance with the Global Initiative For Asthma guidelines (GINA 2014). The phenotype of CD4+CD25highCD127lowFoxp3+CD152+ cells was evaluated by multicolor flow cytometry. The concentration of leptin and its soluble receptor were determined using an immunoenzymatic method (ELISA). Results. It has been shown significantly increased leptin concentration in the group of women with severe asthma compared with mild-moderate asthma and control group (p <0.05). The concentration of the leptin receptor significantly increased (p <0.05) in women with severe asthma compared with control group. There were no differences in percentage of CD4+FoxP3+ and CD4+CD25highCD127low- FoxP3+CD152+ subsets after leptin stimulation in all tested groups. Conclusions. Our results don’t confirm the direct effect of leptin on the CD4+ pTreg cells and the expression of FoxP3 in these cells, in tested groups.

scholarly journals Opazovalna raziskava odraslih bolnikov z neurejeno astmo v zunaj bolnišničnih pnevmoloških ambulantah po Sloveniji.

2019 ◽  
Vol 88 (9-10) ◽  
pp. 415-26
Author(s):  
Stanislav Kajba
Keyword(s):  
Global Initiative For Asthma ◽  
Global Initiative

Izhodišče: Skoraj 50 % bolnikov z astmo ima v klinični praksi kljub zdravljenju po merilih GINA (Global Initiative for Asthma) neurejeno bolezen. Najpogostejši vzroki neurejene astme so: nepravilna uporaba vdihovalnika, slabo sodelovanje bolnika, nepravilna diagnoza astme, pridružene bolezni (rinosinuzitis, GERB (gastroezofagealna refluksna bolezen), debelost, depresija, obstruktivna nočna apneja) in tudi stalna izpostavljenost specifičnim sprožilcem astme (alergeni, zdravila in kajenje).Metode: Med 323 bolniki z neurejeno astmo v 14 zunajbolnišničnih pnevmoloških ambulantah je med decembrom 2017 in aprilom 2018 potekala opazovalna raziskava. Raziskovalci so v svojih ambulantah vnašali podatke o najpogostejših vzrokih za neurejeno astmo in hudih poslabšanjih v zadnjem letu v elektronski sistem za zbiranje podatkov.Rezultati: Najpogostejši dejavniki, povezani z neurejeno astmo, so bile pridružene bolezni v 70 % (debelost 33 %, rinosinusitis 28 %, GERB 22 %), specifični sprožilci v 56 % (izpostavljenost alergenom 39 %, zdravila 35 %, kajenje 10 %) in slabo sodelovanje bolnikov v 53 %. Trideset odstotkov bolnikov je imelo vsaj eno hudo poslabšanje v zadnjem letu. Logistična regresijska analiza je pokazala, da sta nerazumevanje vloge zdravil (95 % IZ: [1,4; 4,8]; p = 0019) in odsotnost individualiziranega načrta samozdravljenja (95 %IZ:[1,3; 4,3]; p = 0,042) najpomembnejša vzroka za huda poslabšanja. Težko astmo po merilih GINA je imelo 23 % bolnikov, vključenih v raziskavo.Zaključek: Najpogostejši dejavniki, ki so povezani z neurejeno astmo pri vzorčni populaciji odraslih bolnikov z neurejeno astmo v zunajbolnišničnih pnevmoloških ambulantah po Sloveniji, so pridružene bolezni, specifični sprožilci in slaba adherenca bolnikov. Ti bolniki imajo še vedno huda poslabšanja. V prihodnosti bo potrebno bolnike z astmo še bolje izobraziti in jih vse oskrbeti z individualiziranim načrtom samozdravljenja astme.

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