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The Global Initiative for Asthma 2019 recommendation for mild asthma – A critique

Elvis M. Irusen
South African Family Practice | Vol 62, No 1 | a5104 | DOI: https://doi.org/10.4102/safp.v62i1.5104 | © 2020 Elvis M. Irusen | This work is licensed under CC Attribution 4.0
Submitted: 10 February 2020 | Published: 05 March 2020

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Elvis M. Irusen, Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa


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Abstract

Recognising that mild asthmatics are at risk of exacerbations and mortality, the Global Initiative for Asthma (GINA) issued an updated strategy in 2019. This was premised on two studies culminating in their recommendation that mild asthma should be treated by using a combination of a rapid and long-acting beta 2 agonist and an inhaled corticosteroid (ICS) administered as required. Their rationale is, however, debatable, as the studies actually showed that regular daily ICS administration was more effective for a number of asthma control endpoints. A patient-driven treatment strategy is also questionable, as there are a number of concerns about behaviour of patients suffering from asthma and perception of airway narrowing that should trigger medication intake but in fact does not do so. These deficiencies also influence a similar maintenance and reliever treatment (MART) approach that would be suboptimal. Intermittent ICS regimens are also inferior when compared to regular treatment. Not all asthmatics respond to the same dose of ICS. The best way to manage asthma is by adopting a step-up ICS approach, to encompass varying disease severity, with a long-acting beta agonist taken on a daily basis, ideally in a single combination inhaler.

Keywords

GINA 2019; mild asthma; regular ICS + LABA combination; critique

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