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Substantial advances have been made in scientific knowledge about the nature of asthma, a wide range of new medications, and understanding of important emotional, behavioural, social and administrative aspects of asthma care.
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The landmark report “Global Strategy for Asthma Management and Prevention”, first published in 1995 and annually updated on the basis of a routine review of evidence, has formed the basis for clinical practice guidelines in many countries. The Global Initiative for Asthma (GINA) was established in 1993 in collaboration with the National Heart, Lung and Blood Institute and the World Health Organization, under the leadership of Drs Suzanne Hurd and Claude Lenfant, with the goals of disseminating information about asthma management, and providing a mechanism to translate scientific evidence into improved asthma care. Asthma is one of the most common chronic diseases affecting children and young adults, and there is increasing recognition of its impact upon working-age adults, the importance of adult-onset asthma, and the contribution of undiagnosed asthma to respiratory symptoms and activity limitation in the elderly. The impact of asthma is felt not only by patients, but also by families, healthcare systems and society. Although some countries have seen a decline in asthma-related hospitalisations and deaths, the global burden for patients from exacerbations and day-to-day symptoms has increased by almost 30% in the past 20 years. The changes include a revised asthma definition tools for assessing symptom control and risk factors for adverse outcomes expanded indications for inhaled corticosteroid therapy a framework for targeted treatment based on phenotype, modifiable risk factors, patient preference, and practical issues optimisation of medication effectiveness by addressing inhaler technique and adherence revised recommendations about written asthma action plans diagnosis and initial treatment of the asthma−chronic obstructive pulmonary disease overlap syndrome diagnosis in wheezing pre-school children and updated strategies for adaptation and implementation of GINA recommendations.Īsthma is a serious global health problem affecting all age groups, with global prevalence ranging from 1% to 21% in adults, and with up to 20% of children aged 6–7 years experiencing severe wheezing episodes within a year.
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This article provides a summary of key changes in the GINA report, and their rationale. During development of the report, the clinical utility of recommendations and strategies for their practical implementation were considered in parallel with the scientific evidence. A major revision of the GINA report was published in 2014, and updated in 2015, reflecting an evolving understanding of heterogeneous airways disease, a broader evidence base, increasing interest in targeted treatment, and evidence about effective implementation approaches. However, uptake of existing guidelines is poor. Over the past 20 years, the Global Initiative for Asthma (GINA) has regularly published and annually updated a global strategy for asthma management and prevention that has formed the basis for many national guidelines.