DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED ASTHMA MANAGEMENT AND PREVENTION GLOBAL STRATEGY FOR Updated 2019 9 Global Strategy for Asthma Management and Prevention (2019 update) DISTRIBUTE OR COPY NOT DO The reader acknowledges that this reportMATERIAL- 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 or national regulations 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 COPYRIGHTEDguidelines. This document should be cited as: Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2019. Available from: www.ginasthma.org 1 Table of contents Tables and figures ............................................................................................................................................................... 5 Preface ................................................................................................................................................................................. 7 Members of GINA committees (2018) ................................................................................................................................. 8 Methodology......................................................................................................................................................................... 9 What’s new in GINA 2019? ................................................................................................................................................ 12 Peer-reviewed publications about the GINA report ........................................................................................................... 14 SECTION 1. ADULTS, ADOLESCENTS AND CHILDREN 6 YEARS AND OLDER ........................................................ 15 Chapter 1. Definition, description, and diagnosis of asthma ........................................................................................... 15 Definition of asthma ................................................................................................................................................... 16 Description of asthma ................................................................................................................................................ 16 Making the initial diagnosis ........................................................................................................................................ 17 Confirming the diagnosis of asthma in patients already taking controller treatment ................................................. 22 DISTRIBUTE Differential diagnosis .................................................................................................................................................. 24 OR How to make the diagnosis of asthma in other contexts ........................................................................................... 25 Chapter 2. Assessment of asthma ................................................................................................COPY .................................... 27 Overview .................................................................................................................................................................... 28 NOT Assessing asthma symptom control .......................................................................................................................... 29 DO Assessing future risk of adverse outcomes ............................................................................................................... 33 Role of lung function in assessing asthma control..................................................................................................... 33 Assessing asthma severity ........................................................................................................................................ 35 Chapter 3. Treating asthma to control symptomsMATERIAL- and minimize risk ................................................................................ 37 Part A. General principles of asthma management ....................................................................................................... 38 Long-term goals of asthma management .................................................................................................................. 38 The patient-health care provider partnership ............................................................................................................. 39 Control-based asthma COPYRIGHTEDmanagement.......................................................................................................................... 40 Part B. Medications and strategies for symptom control and risk reduction .................................................................. 43 Asthma medications ................................................................................................................................................... 44 Reviewing response and adjusting treatment ............................................................................................................ 54 Treating other modifiable risk factors ......................................................................................................................... 57 Other therapies .......................................................................................................................................................... 58 Non-pharmacological strategies ................................................................................................................................ 60 Indications for referral for expert advice .................................................................................................................... 68 Part C. Guided asthma self-management education and skills training ........................................................................ 69 Overview .................................................................................................................................................................... 69 Skills training for effective use of inhaler devices ...................................................................................................... 69 2 Adherence with medications and other advice .......................................................................................................... 70 Asthma information .................................................................................................................................................... 72 Training in guided asthma self-management ............................................................................................................ 73 Part D. Managing asthma with comorbidities and in specific populations ..................................................................... 75 Managing comorbidities ............................................................................................................................................. 75 Managing asthma in specific populations or settings ................................................................................................ 78 Part E. Difficult-to-treat and severe asthma in adults and adolescents ......................................................................... 84 Definitions: uncontrolled, difficult-to-treat and severe asthma ................................................................................... 84 Prevalence: how many people have severe asthma? ............................................................................................... 85 Importance: the impact of severe asthma ................................................................................................................. 85 Investigate and manage adult and adolescent patients with difficult-to-treat asthma ............................................... 91 Assess and treat severe asthma phenotypes ............................................................................................................ 93 Manage and monitor severe asthma treatment ......................................................................................................... 98 Chapter 4. Management of worsening asthma and exacerbations ................................................................................DISTRIBUTE 101 Overview ................................................................................................OR.................................................................. 103 Diagnosis of exacerbations ...................................................................................................................................... 104 COPY Self-management of exacerbations with a written asthma action plan ................................................................... 104 Management of asthma exacerbations in primary care...........................................................................................NOT 108 Management