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2020 GINA Report, Global Strategy for Asthma Management and Prevention

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2020 GINA Report, Global Strategy for Asthma Management and Prevention DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED ASTHMA MANAGEMENT AND PREVENTION GLOBAL STRATEGY FOR © 2020 Global Initiative for Asthma Updated 2020 Global Strategy for Asthma ManagementDISTRIBUTE and Prevention (2020 update) OR COPY NOT DO MATERIAL- The reader acknowledges that this report is intended as an evidence-based asthma management strategy, for the use of health professionals and policy-makers. It is based, to the best of our knowledge, on current best evidence and medical knowledge and practice at the date of publication. When assessing and treating patients, health professionals are strongly advised to use their own professional judgment, and to take into account local and national regulationsCOPYRIGHTED and guidelines. GINA cannot be held liable or responsible for inappropriate healthcare associated with the use of this document, including any use which is not in accordance with applicable local or national regulations or guidelines. This document should be cited as: Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2020. Available from: www.ginasthma.org 1 Table of contents Tables and figures ............................................................................................................................................................. 5 Preface ................................................................................................................................................................................ 7 Members of GINA committees (2019-20) ......................................................................................................................... 8 Methodology ..................................................................................................................................................................... 11 What’s new in GINA 2020? .............................................................................................................................................. 14 Peer-reviewed publications about the GINA report ..................................................................................................... 14 Interim guidance on asthma management during the COVID-19 pandemic ............................................................. 17 SECTION 1. ADULTS, ADOLESCENTS AND CHILDREN 6 YEARS AND OLDER ........................................................... 19 Chapter 1. Definition, description, and diagnosis of asthma .................................................................................... 19 Definition of asthma ................................................................................................................................................... 20 Description of asthma ................................................................................................................................................ 20 Making the initial diagnosis ................................................................................................DISTRIBUTE........................................ 21 Confirming the diagnosis of asthma in patients already taking controller ORtreatment ................................................. 26 Differential diagnosis .................................................................................................................................................. 27 How to make the diagnosis of asthma in other contexts ...........................................................................................COPY 28 Chapter 2. Assessment of asthma ................................................................................................................................ 31 NOT Overview .................................................................................................................................................................... 32 DO Assessing asthma symptom control .......................................................................................................................... 33 Assessing future risk of adverse outcomes ............................................................................................................... 37 Role of lung function in assessing asthma control ..................................................................................................... 37 MATERIAL- Assessing asthma severity ........................................................................................................................................ 39 Chapter 3. Treating asthma to control symptoms and minimize risk ....................................................................... 41 Part A. General principles of asthma management ....................................................................................................... 42 Long-term goals of asthma management .................................................................................................................. 42 The patient-health careCOPYRIGHTED provider partnership ............................................................................................................. 43 Personalized control-based asthma management .................................................................................................... 44 Part B. Medications and strategies for symptom control and risk reduction .................................................................. 47 Asthma medications ................................................................................................................................................... 48 Asthma treatment steps ............................................................................................................................................. 57 Reviewing response and adjusting treatment ............................................................................................................ 64 Treating other modifiable risk factors ......................................................................................................................... 67 Other therapies .......................................................................................................................................................... 68 Non-pharmacological strategies ................................................................................................................................ 70 Indications for referral for expert advice..................................................................................................................... 78 Part C. Guided asthma self-management education and skills training ........................................................................ 79 2 Overview .................................................................................................................................................................... 79 Skills training for effective use of inhaler devices ...................................................................................................... 79 Adherence with medications and other advice .......................................................................................................... 80 Asthma information .................................................................................................................................................... 82 Training in guided asthma self-management ............................................................................................................ 83 Part D. Managing asthma with comorbidities and in specific populations ..................................................................... 85 Managing comorbidities ............................................................................................................................................. 85 Managing asthma in specific populations or settings ................................................................................................ 88 Part E. Difficult-to-treat and severe asthma in adults and adolescents ......................................................................... 94 Definitions: uncontrolled, difficult-to-treat and severe asthma ................................................................................... 94 Prevalence: how many people have severe asthma? ............................................................................................... 95 Importance: the impact of severe asthma.................................................................................................................. 95 Investigate and manage adult and adolescent patients with difficult-to-treat asthma ............................................. 101 Assess and treat severe asthma phenotypes ..........................................................................................................DISTRIBUTE 103 Manage and monitor severe asthma treatment .......................................................................................................OR 108 Chapter 4. Management of worsening asthma and exacerbations ......................................................................... 111 COPY Overview .................................................................................................................................................................. 113 Diagnosis of exacerbations ................................................................................................NOT ...................................... 114 Self-management
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