GINA was established by the WHO and NHLBI in 1993 for management of asthma

COVID-19 & Asthma

  • People with asthma do not appear to be at increased risk of acquiring COVID-19
  • Overall, people with well-controlled asthma are not at increased risk of COVID-19-related death
  • However, the risk of COVID-19 death was increased in people who had recently needed oral corticosteroids (OCS) for their asthma.
  • For patients with severe asthma, continue biologic therapy or oral corticosteroids if prescribed


About Asthma

  •  Asthma is the most common chronic non-communicable disease, affecting over 260 million people globally in 2019
  • Asthma is characterized by variable respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough, and variable expiratory airflow limitation. It is usually associated with airway inflammation 
  • People with asthma often have periods of worsening symptoms and worsening airway obstruction, called exacerbations (also called attacks or flare-ups), that can be fatal 
  • Most of the morbidity and mortality associated with asthma is preventable, particularly with use of inhaled corticosteroids 

In 2019 GINA brought some big changes like

  • GINA no longer recommends SABA-only treatment for Step 1 in adults and adolescents. 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 ICS-containing controller treatment, to reduce the risk of serious exacerbations. The ICS can be delivered by regular daily treatment or, in mild asthma, by as-needed low dose ICS-formoterol

Starting Asthma Treatment

Step 1 Symptoms twice a month or more? RELIEVER: As-needed low-dose ICS formoterol
Step 2 Symptoms most days, or waking at night once a week or more? RELIEVER + Low dose maintenance ICS-formoterol
Step 3 Daily symptoms, waking at night once a week or more and low lung function? RELIEVER + Medium dose maintenance ICS-formoterol. Short course of Oral Corticosteroids maybe needed for patient presenting with severely uncontrolled Asthma
Step 4 Not improved by Step 3 treatment. RELIEVER + Add-on LAMA. Refer for phenotypic assessment ± anti-IgE, anti-IL5/5R, anti-IL4R.Consider high dose ICS-formoterol

Note: GINA 2021 does not distinguish between ‘intermittent’ and ‘mild persistent asthma.