It is time to change the way we manage mild asthma: an update in GINA 2019

Respiratory Research

Table 1 Differences in recommended Step 1 and 2 controller options between GINA 2018 and 2019 [1, 25]

	Controller options	GINA 2018	GINA 2019
Step 1 (Patients with symptoms <twice a month and no exacerbation risk factors)	Preferred	• SABA as-needed and no controller.	• As-needed low dose ICS-formoterol (off- label).
	Other options	• Daily low dose ICS.	• Low dose ICS taken whenever SABA is taken (off-label). This may involve combination (ICS-SABA) in a single or separate (ICS inhaler + SABA inhaler) inhaler/s.
Step 2	Preferred	• Daily low dose ICS.	• Daily low dose ICS. • As-needed low dose ICS-formoterol (off-label)
Step 2	Other options	• Daily LTRA. • Daily low dose ICS-LABA.	• Low dose ICS taken whenever SABA is taken (off-label) • Daily LTRA. • Daily low dose ICS-LABA (better improvement in symptoms and FEV₁ than when ICS is used alone but more costly, and exacerbation rate is similar to the above option).

SABA = Short-acting beta₂ agonist, LABA = Long-acting beta₂ agonist, ICS=Inhaled corticosteroids, LTRA = Leukotriene receptor antagonist, FEV₁ = Forced expiratory volume in one second
Note: (1) The new recommendations in GINA 2019 are highlighted in bold (2) The reliever option in GINA2019 is as-needed low dose ICS-formoterol or as-needed SABA

ISSN: 1465-993X