GINA Guidelines is an Internationally accepted standard Guidelines for ASTHMA . This Power Point Presentation includes 2019 updates and comparison between 2018 and 2019 guidelines.

1. WHAT’S NEW IN
GINA 2019
Mahima K.V
Pharm-D 5th year
N.E.T Pharmacy college, Raichur

2.  GINA stands for Global Initiative for Asthma
 Established in the year 1993
 To increase awareness about asthma among healthcare professionals,
public health authorities and community
 To reduce asthma prevalence, morbidity, and mortality.
About GINA

3.  Asthma is a common and potentially very serious chronic disease
 Characterized by chronic airway inflammation.
 Causing symptoms such as wheezing, shortness of breath, chest
tightness and cough.
variable expiratory airflow due to bronchoconstriction
ASTHMA

4. © Global Initiative for Asthma, www.ginasthma.org
Hekking et al, JACI 2015

5. © Global Initiative for Asthma, www.ginasthma.orgHekking et al, JACI 2015

6. © Global Initiative for Asthma, www.ginasthma.orgHekking et al, JACI 2015

7. Includes :
 Presence of viral fever
 Allergens ( house dust mites, pollens, cockroach etc)
 Tobacco smoking
 Exercise and stress
 Drug induced ( Eg: Beta blockers, aspirin, NSAID’s )
TRIGGERING FACTORS:

8.  The most common phenotypes identified are:
 Allergic asthma
 Non- allergic asthma (sputum test)
 Adult- onset (Late onset) asthma
 Asthma with fixed airway limitation (Incompletely reversible)
 Asthma with obesity
TYPES OF ASTHMA

9.  Diagnosis of asthma depends on two defining features:
 History of respiratory symptoms such as wheeze,
shortness of breath, chest tightness and cough that
vary over the time and in intensity.
 Variable expiratory airflow limitation.
DIAGNOSIS OF ASTHMA:

10. No
Diagnostic flowchart for asthma in clinical practice
Patient with respiratory symptoms
Are the symptoms typical of
Asthma?
Yes
Details History and Examination
History and Examination Supports
Asthma Diagnosis?
No
Further History and
Test for Alternative
Diagnosis
Y
E
S
Treat for Alternative
Diagnosis
Yes
Perform Spirometry / PEF with
Reversibility test
Result Support Asthma Diagnosis?
Yes
Treat for Asthma
Clinical Urgency
Other diagnosis
unlikely
Empiric treatment
with ICS AND prn
SABA
Review response
Diagnostic testing
within 1-3 months

11.  Assess asthma control
 Assess risk factor
 Assess for comorbidities
 Assess treatment issues
Assessing a patient with Asthma

12. Assess asthma control

13. Assess risk factor
 Risk factor for exacerbation
 Risk factor for developing fixed airflow limitation
 Risk factor for medication side effects.

14. Long term goals:
• Risk reduction- Related to death
exacerbations
airway damage
medication side effects
• Symptom control
MANAGEMENT OF ASTHMA

16.  For safety, GINA no longer recommends SABA-only
treatment for Step 1
 This decision was based on evidence that SABA-only
treatment increases the risk of severe exacerbations, and
that adding any ICS significantly reduces the risk
 GINA now recommends that all adults and adolescents with
asthma should receive symptom-driven or regular low dose
ICS-containing controller treatment, to reduce the risk of
serious exacerbations
A MAJOR CHANGES IN GINA 2019 RECOMMENDATIONS
FOR ASTHMA

18. Background to changes in 2019 - the risks
of SABA-only treatment
• Regular or frequent use of SABA is associated with adverse effects
– b-receptor downregulation
– decreased bronchoprotection
– rebound hyperresponsiveness
– decreased bronchodilator response (Hancox, Respir Med 2000)
– Increased allergic response
– increased eosinophilic airway inflammation (Aldridge, AJRCCM 2000)
• Higher use of SABA is associated with adverse clinical outcomes
– Dispensing of average 1.7 puffs/day is associated with higher risk of
emergency department presentations (Stanford, AAAI 2012)

19. GINA 2018

20. GINA 2019

23. INHALED CORTICOSTEROIDS LOW DOSE MEDIUM DOSE HIGH DOSE
Budesonide 200-400mg 400-800mg >800mg
Fluticasone propionate 100-250mg 250-500mg >500mg
Beclomethasone dipropionate 100-200mg 200-400mg >400mg
Low, medium and high doses of Inhaled corticosteroids
in Adults and Adolescents

24. Changes in GINA 2019 – children 6-11 years

28.  Smoking Cessation
 Physical activities
 Healthy diet
 Weight reduction
 Breathing exercise
 Avoidance of occupational exposure
 Avoid Outdoor sir pollutant
 Avoid the drugs which makes the asthma condition worst.
Non pharmacological therapies and strategies

29. REFERENCES:
1. https://ginasthma.org/pocket-guide-for-asthma-management-
and-prevention/
2. https://ginasthma.org/wp-content/uploads/2019/04/GINA-
2019-main-Pocket-Guide-wms.pdf
3. https://ginasthma.org/wp-content/uploads/2018/04/wms-
GINA-2018-report-tracked_v1.3.pdf
4. https://europepmc.org/article/med/17508962
5. https://www.ncbi.nlm.nih.gov/pubmed/23176877