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2004 GINA Report, Global Strategy for Asthma Management and Prevention WR_FullBook_2004 10/6/04 2:53 PM Page a1 DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED ASTHMA MANAGEMENT AND PREVENTION GLOBAL STRATEGY FOR ® U PDATED 2004 WR_FullBook_2004 10/6/04 2:53 PM Page a2 DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED Global Strategy for Asthma Management and Prevention NIH Publication No 02-3659 Issued January, 1995 (updated 2002) Management Segment (Chapter 7): Updated 2004 from the 2003 document. The GINA reports are available on www.ginasthma.org. inside front cover WR_FullBook_2004 10/6/04 2:53 PM Page *1 GINA Workshop Report (Updated 2004) Global Strategy for Asthma Management and Prevention GINA EXECUTIVE COMMITTEE GINA SCIENCE COMMITTEE Paul O’Byrne, M.D., Chair Eric D. Bateman, M.D., Chair McMaster University University of Cape Town Hamilton, Ontario, Canada Cape Town, South Africa Eric D. Bateman, M.D. Peter J. Barnes, D.M., D.Sc. University of Cape Town Imperial College Cape Town, South Africa London, UK Jean Bousquet, M.D., Ph.D. Jean Bousquet, M.D., Ph.D. Montpellier University/INSERM Montpellier University/INSERM Montpellier, France Montpellier, France William W. Busse, M.D. William W. Busse, M.D. University of Wisconsin University of WisconsinDISTRIBUTE Madison, Wisconsin, USA Madison, Wisconsin, USA OR T.J.H. Clark, M.D. Jeffrey M. Drazen, M.D. Imperial College Harvard Medical School London, UK Boston,COPY Massachusetts USA Larry Grouse, M.D., Ph.D. J.NOT Mark FitzGerald, M.D. University of Washington University of British Columbia Seattle, Washington, USA DO Vancouver, British Columbia, Canada Claude Lenfant, M.D. Peter Gibson, M.D. PO Box 83027 John Hunter Hospital Gaithersburg, Maryland, USA NSW 2310 Australia MATERIAL- Ken Ohta. M.D. Johan Kips, M.D. Teikyo University School of Medicine Ghent University Hospital Tokyo, Japan B 9000 Gent, Belgium Soren Erik Pedersen, M.D. Paul O’Byrne, M.D., Chair Kolding Hospital McMaster University Kolding, Denmark Hamilton, Ontario, Canada COPYRIGHTED Raj B Singh M.D. Ken Ohta. M.D. Apollo Hospital Teikyo University School of Medicine Chennai, India Tokyo, Japan Wan-Cheng Tan, M.D. Soren Erik Pedersen, M.D. National University Hospital Kolding Hospital Singapore Kolding, Denmark Sally E. Wenzel, M.D. National Jewish Medical/Research Center Denver, Colorado, USA iii WR_FullBook_2004 10/6/04 2:53 PM Page *2 GINA DISSEMINATION Ron Tomlins, M.D. COMMITTEE Director, Future Medical Concepts, NSW, Australia Wan-Cheng Tan, M.D., Chair National University of Singapore Onno van Schyack, M.D. Singapore University of Maastricht Masstricht, The Netherlands. Gabriel Anabwani, M.D. Princess Marina Hospital Heather Zar, M.D. Caborone. Botswana Orangezicht, South Africa Richard Beasley, M.D. Medical Research Institute of NZ Wellington, New Zealand Hisbello Campos, M.D. Rio de Janeiro, RJ Brazil Yu Zhi Chen, M.D. Beijing, China DISTRIBUTE OR Frode Gallefoss, M.D. Vest-Agder Central Hospital Kristiansand, Norway COPY Michiko Haida, M.D. Hanzomon Hospital, NOT Chiyoda-ku, Tokyo, Japan. DO Javaid A. Khan, M.D. The Aga Khan University Karachi, Pakistan Ron Neville, M.D. MATERIAL- Tayside Centre for General Practice Dundee, Scotland, UK Jeyaindaran Sinnadurai, M.D. Hospital Kuala Lumpur Kuala Lumpur, Malaysia COPYRIGHTED Raj B Singh M.D. Apollo Hospital Chennai, India iv WR_FullBook_2004 10/6/04 2:53 PM Page *3 PREFACE Asthma is a serious global health problem. People of all held seminars at national and international meetings, and ages in countries throughout the world are affected by this helped support a “train the trainer” program through the chronic airway disorder that can be severe and sometimes National Research Training Center in the UK. fatal. The prevalence of asthma is increasing everywhere, especially among children. Asthma is a significant burden, In 2000, the GINA Executive Committee recommended not only in terms of health care costs but also of lost updating the 1995 Workshop Report to incorporate new productivity and reduced participation in family life. scientific information. The methods used to prepare the update are described in the Introduction. It is a privilege During the past two decades, we have witnessed many for me to acknowledge the work of the many people who scientific advances that have improved our understanding participated in this update project, as well as to of asthma and our ability to manage it effectively. acknowledge the superlative work of all who have However, the diversity of national health care service contributed to the success of the GINA program. systems and variations in the availability of asthma therapies require that recommendations for asthma care The GINA program has been conducted through be adapted to local conditions throughout the global educational grants from Altana, Andi-Ventis, AstraZeneca, community. In addition, public health officials require Aventis, Bayer, Boehringer Ingelheim, Chiesi Group, information about the costs of asthma care, how to GlaxoSmithKline, Merck,DISTRIBUTE Sharp & Dohme, , Mitsubishi- effectively manage this chronic disease, and best Pharma Corporation, Nikken Chemicals Co., LTD., education methods in order to develop asthma care Novartis, Schering-PloughOR International, Sepracor and services and programs responsive to the particular needs Viatris. The generous contributions of these companies and circumstances within their countries. assured that workshop members could meet together to discussCOPY issues and reach consensus in a constructive and Accordingly, in 1993, the National Heart, Lung, and Blood timely manner. The workshop members are, however, Institute collaborated with the World Health Organization to solelyNOT responsible for the statements and conclusions convene a workshop that led to the Global Strategy for presented in this publication. Asthma Management and Prevention, a Workshop Report DO that presented a comprehensive plan to manage asthma The GINA publications are available through the Internet with the goal of reducing chronic disability and premature (http://www.ginasthma.com). deaths while allowing patients with asthma to lead productive and fulfilling lives. Paul O'Byrne, MD Hamilton, Ontario, Canada At the same time, a program called the GlobalMATERIAL- Initiative for Chair, GINA Executive Committee Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Three publications based on the Workshop Report were prepared to COPYRIGHTEDpromote international collaboration and dissemination of information: • Asthma Management and Prevention: A Practical Guide for Public Health Officials and Health Care Professionals • Pocket Guide for Asthma Management and Prevention • What You and Your Family Can Do About Asthma These documents have been widely disseminated, and translated into several languages. GINA has conducted workshops with local doctors and national opinion leaders, v WR_FullBook_2004 10/6/04 2:53 PM Page *4 DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED vi WR_FullBook_2004 10/6/04 2:53 PM Page *5 Methodology and Summary of New Recommendations Global Strategy for Asthma Management and Prevention: 2004 Update When the Global Initiative for Asthma (GINA) program was judgment, the full publication, by answering specific written initiated in 1993, the first goal was to produce questions from a short questionnaire, and to indicate if the recommendations for asthma management based on the scientific data presented impacted on recommendations in best scientific information available. Its first report, the GINA Workshop report. If so, the member was asked NHLBI/WHO Workshop Report: Global Strategy for to specifically identify modifications that should be made. Asthma Management and Prevention was issued in 1995. The entire GINA Science Committee met on a regular This report, and its companion documents, have been basis to discuss each individual publication that was widely distributed and translated into many languages. The indicated to have an impact on asthma management and 1995 report was revised in 2002 under the leadership of prevention by at least 1 member of the Committee, and to the GINA Executive Committee and can be found on the reach a consensus on the changes in the report. GINA website (www.ginasthma.org). The 2002 report, a Disagreements were decided by vote. revision of the entire document, was based on research published through 2000. Summary of Recommendations in the 2004 Update: Between January 1 andDISTRIBUTE December 31, 2003, 319 articles In an effort to keep the 2002 GINA Workshop report as up met the search ORcriteria. Of these, 29 papers were identified to date as possible, a GINA Science Committee * was to have an impact on the GINA Workshop Report that was established to review published research on asthma posted on the website in October 2003 either by: 1) management and prevention, to evaluate the impact of confirming,COPY that is, adding or replacing an existing this research on recommendations in the GINA documents reference, or 2) modifying, that is, changing the text or related to management and prevention, and to post yearly introducing a concept that required a new recommendation updates on the GINA website. A 2003 update was posted toNOT the report. The major modifications introduced in the in October 2003 and included the impact of publications DO management section in this 2004 update
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