DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED ASTHMA MANAGEMENT AND PREVENTION ONLINE APPENDIX GLOBAL STRATEGY FOR © 2019 Global Initiative for Asthma UPDATED 2019 DISTRIBUTE OR This online Appendix contains background and supplementary material for the Global Initiative for Asthma (GINA) 2019 Global StrategyCOPY Repor t for Asthma Management and Prevention. The full GINA report and other GINA resources are available at www.ginastNOThma. org DO This document is intended as a general guide for 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 stronMATERIAL-gly a dvised to consult a variety of sources and to use their own professional judgment. GINA cannot be held liable or responsible for healthcare administered with the use of this document, including any use which is not in accordance with applicable local or national regulations or guidelines. COPYRIGHTED GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION ONLINE APPENDIX DISTRIBUTE 2019 OR COPY NOT DO This online Appendix contains background and supplementary material for the Global Initiative for Asthma (GINA) 2019 Global Strategy Report for Asthma Management and Prevention. The full GINA report and other GINA resources are available MATERIAL-at www.ginasthma.com This document is intended to provide background information for the full GINA 2019 report, as a general guide for 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 consult a variety of sources and to use their COPYRIGHTED 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 guidelines. DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED TABLE OF CONTENTS Chapter 1. The burden of asthma .............................................................................................................................. 7 Prevalence, morbidity and mortality ............................................................................................................................... 7 Social and economic burden ........................................................................................................................................... 9 Reducing the burden of asthma ...................................................................................................................................... 9 Chapter 2. Factors affecting the development and expression of asthma...................................................................11 Background .................................................................................................................................................................... 11 Host factors .................................................................................................................................................................... 12 Environmental factors ................................................................................................................................................... 13 Chapter 3. Mechanisms of asthma ...........................................................................................................................17 Airway inflammation in asthma .................................................................................................................................... 17 Structural changes in the airways .................................................................................................................................. 20 DISTRIBUTE Pathophysiology ............................................................................................................................................................ 20 OR Special mechanisms in specific contexts ....................................................................................................................... 21 Chapter 4. Tests for diagnosis and monitoring of asthma ..........................................................................................COPY 23 Measuring lung function ................................................................................................NOT ................................................ 23 Non-invasive markers of airway inflammation .............................................................................................................DO 26 Chapter 5. Asthma pharmacotherapy ......................................................................................................................29 Part A. Asthma pharmacotherapy - adults and adolescents ............................................................................................. 29 Route of Administration ................................................................................................MATERIAL- ................................................ 29 Controller medications .................................................................................................................................................. 29 Add-on controller medications ...................................................................................................................................... 34 Reliever medications ..................................................................................................................................................... 39 Other medications ................................................................................................COPYRIGHTED ......................................................... 40 Complementary and alternative medicines and therapies ........................................................................................... 41 Part B. Asthma pharmacotherapy – children 6–11 years ............................................................................................. 43 Route of administration ................................................................................................................................................. 43 Controller medications .................................................................................................................................................. 44 Add-on controller medications ...................................................................................................................................... 48 Reliever medications ..................................................................................................................................................... 50 Other medications, not recommended for use in children ........................................................................................... 50 Part C. Asthma pharmacotherapy – children 5 years and younger .............................................................................. 51 3 Controller medications .................................................................................................................................................. 51 Reliever medications ..................................................................................................................................................... 54 Chapter 6. Implementing asthma management strategies in health systems ............................................................ 55 Introduction ................................................................................................................................................................... 55 Planning an implementation strategy ........................................................................................................................... 56 Economic value of implementing management recommendations for asthma care ................................................... 61 GINA dissemination and implementation resources ..................................................................................................... 61 DISTRIBUTE OR COPY NOT DO MATERIAL- COPYRIGHTED 4 TABLE OF FIGURES BURDEN OF ASTHMA Box A1-1. World map of the prevalence of current asthma in children aged 13–14 years ............................................. 7 Box A1-2. Prevalence of current asthma in 2000–2003 in children aged 13–14 years (%) ............................................ 8 DEVELOPMENT AND EXPRESSION OF ASTHMA Box A2-1. Factors influencing the development and expression of asthma .................................................................. 11 Box A3-1. Inflammatory cells in asthmatic airways ........................................................................................................ 17 MECHANISMS Box A3-2. Structural cells in asthmatic airways ............................................................................................................. 18 Box A3-3. Key cellular mediators in asthma .................................................................................................................. 19 Box A3-4. Structural changes in asthmatic airways ......................................................................................................