Transcript Global Initiative for Asthma

GLOBAL INITIATIVE FOR ASTHMA (GINA)
TEACHING SLIDE SET
January 2013
This slide set is restricted for academic and
educational purposes only. Use of the slide set,
or of individual slides, for commercial or
promotional purposes requires approval from
GINA.
© Global Initiative for Asthma
G lobal
INitiative for
A sthma
© Global Initiative for Asthma
GINA Program Objectives
 Increase appreciation of asthma as a global public
health problem
 Present key recommendations for diagnosis and
management of asthma
 Provide strategies to adapt recommendations to
varying health needs, services, and resources
 Identify areas for future investigation of particular
significance to the global community
© Global Initiative for Asthma
GINA Structure
Executive Committee
Chair: Mark FitzGerald, MD
Dissemination
Committee
Science
Committee
Chair: L.B. Boulet, MD
Chair: Helen Reddel, MD
© Global Initiative for Asthma
GINA Board of Directors
M. FitzGerald, Chair, Canada
E. Bateman, S. Africa P. Paggario, Italy
L.P. Boulet, Canada S. Pedersen, Denmark
A. Cruz, Brazil
H. Reddel, Australia
M. Haahtela, Finland M. Soto-Quiroz, Costa Rica
M. Levy, U.K.
G. Wong, Hong Kong ROC
P. O’Byrne, Canada
© Global Initiative for Asthma
GINA Science Committee
H. Reddel, Chair, Australia
N. Barnes, UK
M. FitzGerald, Canada
P. Barnes, UK
R. Lemanske, US
A. Becker, Canada
P. O’Byrne, Canada
E. Bel, Netherlands
E. Pizzichini, Brazil
J. DeJongste, Netherlands S. Pedersen, Denmark
J. Drazen, US
H. Reddel, Australia
© Global Initiative for Asthma
GINA Structure
Executive Committee
Chair: Mark FitzGerald, MD
Dissemination
Committee
Science
Committee
Chair: L.P. Boulet, MD
Chair: H. Reddel, MD
GINA ASSEMBLY
© Global Initiative for Asthma
GINA Assembly

A network of individuals participating in
the dissemination and implementation of
asthma management programs at the
local, national and regional level

GINA Assembly members are invited to
meet with the GINA Executive Committee
during the ATS and ERS meetings
© Global Initiative for Asthma
Saudi Arabia
Bangladesh
Pakistan
Israel
Slovenia
Germany
Ireland
Yugoslavia Croatia
Australia
Canada
Brazil
Austria
United States
Taiwan
Portugal
Thailand
Philippines
Malta
Greece
Mexico
Moldova
China
Syria
Egypt
South Africa
United Kingdom
Hong Kong ROC Chile
New Zealand
Italy
Venezuela Cambodia
Argentina
Lebanon
Mongolia
Poland Korea
Switzerland
GINA Assembly
Russia
Turkey Czech
India
Macedonia
France
Sweden
Albania
Netherlands
Georgia
Denmark
Belgium
Slovakia
Republic
Colombia Ukraine
Romania
Japan
Singapore
Kyrgyzstan
Spain
Vietnam
GINA Documents
 Global Strategy for Asthma Management and
Prevention (updated 2012)
 Pocket Guide: Asthma Management and Prevention
(updated 2012)
 Global Strategy for Asthma Management and
Prevention for Children 5 Years and Younger (2009)
 Pocket Guide: Asthma Management and Prevention in
Children 5 Years and younger (2009)
 Guide for asthma patients and families
All materials are available on GINA web site www.ginasthma.org
© Global Initiative for Asthma
Global Strategy for Asthma
Management and Prevention
 Evidence-based
 Implementation oriented
Diagnosis
Management
Prevention
 Outcomes can be evaluated
© Global Initiative for Asthma
Global Strategy for Asthma
Management and Prevention
Evidence Category
Sources of Evidence
A
Randomized clinical trials
Rich body of data
B
Randomized clinical trials
Limited body of data
C
Non-randomized trials
Observational studies
D
Panel judgment consensus
© Global Initiative for Asthma
Global Strategy for Asthma
Management and Prevention (2012)
Definition and Overview
 Diagnosis and Classification
 Asthma Medications
 Asthma Management and
Prevention Program
 Implementation of Asthma
Guidelines in Health
Systems

Updated 2012
© Global Initiative for Asthma
Definition of Asthma

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airway
hyperresponsiveness that leads to recurrent
episodes of wheezing, breathlessness, chest
tightness, and coughing

Widespread, variable, and often reversible
airflow limitation
© Global Initiative for Asthma
Asthma Inflammation: Cells and Mediators
Source: Peter J. Barnes, MD
Mechanisms: Asthma Inflammation
Source: Peter J. Barnes, MD
Asthma Inflammation: Cells and Mediators
Source: Peter J. Barnes, MD
Burden of Asthma

Asthma is one of the most common chronic
diseases worldwide with an estimated 300
million affected individuals

Prevalence increasing in many countries,
especially in children

A major cause of school/work absence
© Global Initiative for Asthma
Burden of Asthma

Health care expenditures very high

Developed economies might expect to
spend 1-2 percent of total health care
expenditures on asthma. Developing
economies likely to face increased demand

Poorly controlled asthma is expensive;
investment in prevention medication likely
to yield cost savings in emergency care
© Global Initiative for Asthma
Asthma Prevalence and Mortality
Source: Masoli M et al. Allergy 2004
Countries should enter their
own data on burden of
asthma.
Risk Factors for Asthma

Host factors: predispose individuals to, or
protect them from, developing asthma

Environmental factors: influence
susceptibility to development of asthma in
predisposed individuals, precipitate asthma
exacerbations, and/or cause symptoms to
persist
© Global Initiative for Asthma
Factors that Exacerbate Asthma






Allergens
Respiratory infections
Exercise and hyperventilation
Weather changes
Sulfur dioxide
Food, additives, drugs
© Global Initiative for Asthma
Factors that Influence Asthma
Development and Expression
Host Factors
 Genetic
- Atopy
- Airway
hyperresponsiveness
 Gender
 Obesity
Environmental Factors
 Indoor allergens
 Outdoor allergens
 Occupational sensitizers
 Tobacco smoke
 Air Pollution
 Respiratory Infections
 Diet
© Global Initiative for Asthma
Is it Asthma?

Recurrent episodes of wheezing

Troublesome cough at night

Cough or wheeze after exercise

Cough, wheeze or chest tightness
after exposure to airborne allergens
or pollutants

Colds “go to the chest” or take more
than 10 days to clear
© Global Initiative for Asthma
Asthma Diagnosis


History and patterns of symptoms
Measurements of lung function
- Spirometry
- Peak expiratory flow

Measurement of airway responsiveness

Measurements of allergic status to identify risk
factors

Extra measures may be required to diagnose
asthma in children 5 years and younger and the
elderly
© Global Initiative for Asthma
Typical Spirometric (FEV1)
Tracings
Volume
FEV1
Normal Subject
Asthmatic (After Bronchodilator)
Asthmatic (Before Bronchodilator)
1
2
3
4
Time (sec)
5
Note: Each FEV1 curve represents the highest of three repeat measurements
© Global Initiative for Asthma
Measuring Variability of Peak
Expiratory Flow
Measuring Airway Responsiveness
© Global Initiative for Asthma
Asthma Management and Prevention
Program: Five Components
1. Develop Patient/Doctor
Partnership
2. Identify and Reduce Exposure
to Risk Factors
3. Assess, Treat and Monitor
Asthma
4. Manage Asthma Exacerbations
Updated 2012
5. Special Considerations
© Global Initiative for Asthma
Asthma Management and Prevention Program
Goals of Long-term Management
Achieve and maintain control of symptoms
 Maintain normal activity levels, including
exercise
 Maintain pulmonary function as close to
normal levels as possible
 Prevent asthma exacerbations
 Avoid adverse effects from asthma
medications
 Prevent asthma mortality

© Global Initiative for Asthma
Asthma Management and Prevention
Program: Five Interrelated Components
1. Develop Patient/Doctor Partnership
2. Identify and Reduce Exposure to
Risk Factors
3. Assess, Treat and Monitor Asthma
4. Manage Asthma Exacerbations
5. Special Considerations
© Global Initiative for Asthma
Asthma Management and
Prevention Program
.

Asthma can be effectively controlled in
most patients by intervening to suppress
and reverse inflammation as well as
treating bronchoconstriction and related
symptoms

Early intervention to stop exposure to the
risk factors that sensitized the airway may
help improve the control of asthma and
reduce medication needs.
© Global Initiative for Asthma
Asthma Management and
Prevention Program

Although there is no cure for asthma,
appropriate management that includes
a partnership between the physician
and the patient/family most often
results in the achievement of control
© Global Initiative for Asthma
Asthma Management and Prevention Program
Part 1: Educate Patients to
Develop a Partnership
 Guidelines on asthma management
should be available but adapted and
adopted for local use by local asthma
planning teams
 Clear communication between health
care professionals and asthma patients
is key to enhancing compliance
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 1: Develop
Patient/Doctor Partnership

Educate continually

Include the family

Provide information about asthma

Provide training on self-management skills

Emphasize a partnership among health
care providers, the patient, and the
patient’s family
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 1: Develop
Patient/Doctor Partnership
Key factors to facilitate communication:
 Friendly demeanor
 Interactive dialogue
 Encouragement and praise
 Provide appropriate information
 Feedback and review
© Global Initiative for Asthma
Example Of Contents Of An Action Plan To Maintain Asthma Control
Your Regular Treatment:
1. Each day take ___________________________
2. Before exercise, take _____________________
WHEN TO INCREASE TREATMENT
Assess your level of Asthma Control
In the past week have you had:
Daytime asthma symptoms more than 2 times ?
No
Yes
Activity or exercise limited by asthma?
No
Yes
Waking at night because of asthma?
No
Yes
The need to use your [rescue medication] more than 2 times?
No
Yes
If you are monitoring peak flow, peak flow less than________? No
Yes
If you answered YES to three or more of these questions, your asthma is uncontrolled and you may need to
step up your treatment.
HOW TO INCREASE TREATMENT
STEP-UP your treatment as follows and assess improvement every day:
____________________________________________ [Write in next treatment step here]
Maintain this treatment for _____________ days [specify number]
WHEN TO CALL THE DOCTOR/CLINIC.
Call your doctor/clinic: _______________ [provide phone numbers]
If you don’t respond in _________ days [specify number]
______________________________ [optional lines for additional instruction]
EMERGENCY/SEVERE LOSS OF CONTROL
If you have severe shortness of breath, and can only speak in short sentences,
If you are having a severe attack of asthma and are frightened,
If you need your reliever medication more than every 4 hours and are not improving.
1. Take 2 to 4 puffs ___________ [reliever medication]
2. Take ____mg of ____________ [oral glucocorticosteroid]
3. Seek medical help: Go to _____________________; Address___________________
Phone: _______________________
4. Continue to use your _________[reliever medication] until you are able to get medical help.
© Global Initiative for Asthma
Asthma Management and Prevention Program
Factors Involved in Non-Adherence
Medication Usage

Difficulties associated
with inhalers

Complicated regimens

Fears about, or actual
side effects

Cost

Distance to pharmacies
Non-Medication Factors

Misunderstanding/lack of
information

Fears about side-effects

Inappropriate expectations

Underestimation of severity

Attitudes toward ill health

Cultural factors

Poor communication
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 2: Identify and Reduce
Exposure to Risk Factors
 Measures to prevent the development of asthma,
and asthma exacerbations by avoiding or reducing
exposure to risk factors should be implemented
wherever possible.
 Asthma exacerbations may be caused by a variety
of risk factors – allergens, viral infections,
pollutants and drugs.
 Reducing exposure to some categories of risk
factors improves the control of asthma and
reduces medications needs.
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 2: Identify and Reduce
Exposure to Risk Factors

Reduce exposure to indoor allergens

Avoid tobacco smoke

Avoid vehicle emission

Identify irritants in the workplace

Explore role of infections on asthma
development, especially in children and
young infants
© Global Initiative for Asthma
Asthma Management and Prevention Program
Influenza Vaccination
 Influenza vaccination should be
provided to patients with asthma when
vaccination of the general population is
advised
 However, routine influenza vaccination
of children and adults with asthma
does not appear to protect them from
asthma exacerbations or improve
asthma control
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 3: Assess, Treat
and Monitor Asthma
The goal of asthma treatment, to
achieve and maintain clinical
control, can be achieved in a
majority of patients with a
pharmacologic intervention strategy
developed in partnership between
the patient/family and the health
care professional
© Global Initiative for Asthma
Global Strategy for Asthma Management and Prevention
Clinical Control of Asthma
The focus on asthma control is
important because:
 the attainment of control correlates
with a better quality of life, and
 reduction in health care use
© Global Initiative for Asthma
Global Strategy for Asthma Management and Prevention
Clinical Control of Asthma
 Determine the initial level of
control to implement treatment
(assess patient impairment)
 Maintain control once treatment
has been implemented
(assess patient risk)
© Global Initiative for Asthma
Levels of Asthma Control
(Assess patient impairment)
Characteristic
Controlled
Partly controlled
(All of the following)
(Any present in any week)
Daytime symptoms
Twice or less
per week
More than
twice per week
Limitations of
activities
None
Any
Nocturnal symptoms
/ awakening
None
Any
Need for rescue /
“reliever” treatment
Twice or less
per week
More than
twice per week
Normal
< 80% predicted or
personal best (if
known) on any day
Lung function
(PEF or FEV1)
Uncontrolled
3 or more
features of
partly
controlled
asthma
present in
any week
Assessment of Future Risk (risk of exacerbations, instability, rapid
decline in lung function, side effects)
© Global Initiative for Asthma
Assess Patient Risk
Features that are associated with increased
risk of adverse events in the future include:
 Poor clinical control
 Frequent exacerbations in past year
 Ever admission to critical care for asthma
 Low FEV1, exposure to cigarette smoke,
high dose medications
© Global Initiative for Asthma
Assessment of Future Risk
Risk of exacerbations, instability, rapid decline
in
lungexacerbation
function, side effects
Any
should prompt review
Features that are associated with increased
of maintenance
risk of adverse
events in the future include:
 Poor clinical
control
treatment
 Frequent exacerbations in past year
 Ever admission to critical care for asthma
 Low FEV1, exposure to cigarette smoke,
high dose medications
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 3: Assess, Treat
and Monitor Asthma
 Depending on level of asthma control,
the patient is assigned to one of five
treatment steps
 Treatment is adjusted in a continuous
cycle driven by changes in asthma
control status. The cycle involves:
- Assessing Asthma Control
- Treating to Achieve Control
- Monitoring to Maintain Control
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 3: Assess, Treat
and Monitor Asthma

A stepwise approach to pharmacological
therapy is recommended

The aim is to accomplish the goals of
therapy with the least possible medication

Although in many countries traditional
methods of healing are used, their efficacy
has not yet been established and their use
can therefore not be recommended
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 3: Assess, Treat
and Monitor Asthma
The choice of treatment should be guided by:

Level of asthma control

Current treatment

Pharmacological properties and availability
of the various forms of asthma treatment

Economic considerations
Cultural preferences and differing health care
systems need to be considered
© Global Initiative for Asthma
Controller Medications
Inhaled glucocorticosteroids
 Leukotriene modifiers
 Long-acting inhaled β2-agonists in combination
with inhaled glucocorticosteroids
 Systemic glucocorticosteroids
 Theophylline
 Cromones
 Anti-IgE

© Global Initiative for Asthma
Estimate Comparative Daily Dosages for
Inhaled Glucocorticosteroids by Age
Drug
Low Daily Dose (g)
> 5 y Age < 5 y
Medium Daily Dose (g)
> 5 y Age < 5 y
Beclomethasone
200-500
100-200
>500-1000
>200-400
Budesonide
200-600
100-200
600-1000
>200-400
Budesonide-Neb
Inhalation Suspension
Ciclesonide
250-500
80 – 160
High Daily Dose (g)
> 5 y Age < 5 y
>1000
>1000
500-1000
>400
>400
>1000
80-160
>160-320
>160-320
>320-1280
>320
Flunisolide
500-1000
500-750
>1000-2000
>750-1250
>2000
>1250
Fluticasone
100-250
100-200
>250-500
>200-500
>500
>500
Mometasone furoate
200-400
100-200
> 400-800
>200-400
>800-1200
Triamcinolone acetonide
400-1000
400-800
>1000-2000
>800-1200
>2000
© Global Initiative for Asthma
>400
>1200
Reliever Medications
 Rapid-acting inhaled β2-agonists
 Systemic glucocorticosteroids
 Anticholinergics
 Theophylline
 Short-acting oral β2-agonists
© Global Initiative for Asthma
Component 4: Asthma Management and Prevention Program
Allergen-specific Immunotherapy




Greatest benefit of specific immunotherapy
using allergen extracts has been obtained in
the treatment of allergic rhinitis
The role of specific immunotherapy in asthma is
limited
Specific immunotherapy should be considered
only after strict environmental avoidance and
pharmacologic intervention, including inhaled
glucocorticosteroids, have failed to control
asthma
Perform only by trained physician
© Global Initiative for Asthma
REDUCE
LEVEL OF CONTROL
TREATMENT OF ACTION
maintain and find lowest
controlling step
partly controlled
consider stepping up to
gain control
INCREASE
controlled
uncontrolled
exacerbation
step up until controlled
treat as exacerbation
REDUCE
INCREASE
TREATMENT STEPS
STEP
STEP
STEP
STEP
STEP
1
2
3
4
5
© Global Initiative for Asthma
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
Shaded green - preferred controller options
TO STEP 4 TREATMENT,
ADD EITHER
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
Shaded green - preferred controller options
TO STEP 4 TREATMENT,
ADD EITHER
Treating to Achieve Asthma Control
Step 1 – As-needed reliever medication
 Patients with occasional daytime symptoms of
short duration
 A rapid-acting inhaled β2-agonist is the
recommended reliever treatment (Evidence A)
 When symptoms are more frequent, and/or
worsen periodically, patients require regular
controller treatment (step 2 or higher)
© Global Initiative for Asthma
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
Shaded green - preferred controller options
TO STEP 4 TREATMENT,
ADD EITHER
Treating to Achieve Asthma Control
Step 2 – Reliever medication plus a single
controller
 A low-dose inhaled glucocorticosteroid is
recommended as the initial controller
treatment for patients of all ages (Evidence A)
 Alternative controller medications include
leukotriene modifiers (Evidence A)
appropriate for patients unable/unwilling to
use inhaled glucocorticosteroids
© Global Initiative for Asthma
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
Shaded green - preferred controller options
TO STEP 4 TREATMENT,
ADD EITHER
Treating to Achieve Asthma Control
Step 3 – Reliever medication plus one or two
controllers
 For adults and adolescents, combine a low-dose
inhaled glucocorticosteroid with an inhaled longacting β2-agonist either in a combination inhaler
device or as separate components (Evidence A)
 Inhaled long-acting β2-agonist must not be used
as monotherapy
 For children, increase to a medium-dose inhaled
glucocorticosteroid (Evidence A)
© Global Initiative for Asthma
Treating to Achieve Asthma Control
Additional Step 3 Options for Adolescents and Adults
 Increase to medium-dose inhaled
glucocorticosteroid (Evidence A)
 Low-dose inhaled glucocorticosteroid
combined with leukotriene modifiers
(Evidence A)
 Low-dose sustained-release theophylline
(Evidence B)
© Global Initiative for Asthma
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
Shaded green - preferred controller options
TO STEP 4 TREATMENT,
ADD EITHER
Treating to Achieve Asthma Control
Step 4 – Reliever medication plus two or more
controllers
 Selection of treatment at Step 4 depends
on prior selections at Steps 2 and 3
 Where possible, patients not controlled on
Step 3 treatments should be referred to a
health professional with expertise in the
management of asthma
© Global Initiative for Asthma
Treating to Achieve Asthma Control
Step 4 – Reliever medication plus two or more controllers
 Medium- or high-dose inhaled glucocorticosteroid
combined with a long-acting inhaled β2-agonist
(Evidence A)
 Medium- or high-dose inhaled glucocorticosteroid
combined with leukotriene modifiers (Evidence A)
 Low-dose sustained-release theophylline added
to medium- or high-dose inhaled
glucocorticosteroid combined with a long-acting
inhaled β2-agonist (Evidence B)
© Global Initiative for Asthma
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
Shaded green - preferred controller options
TO STEP 4 TREATMENT,
ADD EITHER
Treating to Achieve Asthma Control
Step 5 – Reliever medication plus additional controller options
 Addition of oral glucocorticosteroids to other
controller medications may be effective
(Evidence D) but is associated with severe
side effects (Evidence A)
 Addition of anti-IgE treatment to other
controller medications improves control of
allergic asthma when control has not been
achieved on other medications (Evidence A)
© Global Initiative for Asthma
Treating to Maintain Asthma Control
 When control as been achieved,
ongoing monitoring is essential to:
- maintain control
- establish lowest step/dose treatment
 Asthma control should be monitored
by the health care professional and
by the patient
© Global Initiative for Asthma
Treating to Maintain Asthma Control
Stepping down treatment when asthma is controlled
 When controlled on medium- to high-dose
inhaled glucocorticosteroids: 50% dose
reduction at 3 month intervals (Evidence
B)
 When controlled on low-dose inhaled
glucocorticosteroids: switch to once-daily
dosing (Evidence A)
© Global Initiative for Asthma
Treating to Maintain Asthma Control
Stepping down treatment when asthma is controlled
 When controlled on combination inhaled
glucocorticosteroids and long-acting
inhaled β2-agonist, reduce dose of inhaled
glucocorticosteroid by 50% while
continuing the long-acting β2-agonist
(Evidence B)
 If control is maintained, reduce to lowdose inhaled glucocorticosteroids and
stop long-acting β2-agonist (Evidence D)
© Global Initiative for Asthma
Treating to Maintain Asthma Control
Stepping up treatment in response to loss of control
 Rapid-onset, short-acting or longacting inhaled β2-agonist
bronchodilators provide temporary
relief.
 Need for repeated dosing over more
than one/two days signals need for
possible increase in controller therapy
© Global Initiative for Asthma
Treating to Maintain Asthma Control
Stepping up treatment in response to loss of control
 Use of a combination rapid and long-acting
inhaled β2-agonist (e.g., formoterol) and an
inhaled glucocorticosteroid (e.g., budesonide)
in a single inhaler both as a controller and
reliever is effecting in maintaining a high level
of asthma control and reduces exacerbations
(Evidence A)
 Doubling the dose of inhaled glucocorticosteroids is not effective, and is not
recommended (Evidence A)
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 4: Manage Asthma
Exacerbations
 Exacerbations of asthma are episodes of
progressive increase in shortness of breath,
cough, wheezing, or chest tightness
 Exacerbations are characterized by decreases
in expiratory airflow that can be quantified and
monitored by measurement of lung function
(FEV1 or PEF)
 Severe exacerbations are potentially lifethreatening and treatment requires close
supervision
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 4: Manage Asthma
Exacerbations
Treatment of exacerbations depends on:
 The patient
 Experience of the health care professional
 Therapies that are the most effective for
the particular patient
 Availability of medications
 Emergency facilities
© Global Initiative for Asthma
Asthma Management and Prevention Program
Component 4: Manage Asthma
Exacerbations
Primary therapies for exacerbations:
• Repetitive administration of rapid-acting inhaled
β2-agonist
• Early introduction of systemic
glucocorticosteroids
• Oxygen supplementation
Closely monitor response to treatment with serial
measures of lung function
© Global Initiative for Asthma
Asthma Management and Prevention Program
Special Considerations
Special considerations are required to
manage asthma in relation to:
 Pregnancy
 Surgery
 Rhinitis, sinusitis, and nasal polyps
 Occupational asthma
 Respiratory infections
 Gastroesophageal reflux
 Aspirin-induced asthma
 Anaphylaxis and Asthma
© Global Initiative for Asthma
Global Strategy
for the Diagnosis
and Management
of Asthma in
Children 5 Years
and Younger
2009
www.ginasthma.org
© Global Initiative for Asthma
Asthma Management and
Prevention Program: Summary


Asthma can be effectively controlled in most
patients by intervening to suppress and reverse
inflammation as well as treating
bronchoconstriction and related symptoms
Although there is no cure for asthma,
appropriate management that includes a
partnership between the physician and the
patient/family most often results in the
achievement of control
© Global Initiative for Asthma
Asthma Management and
Prevention Program: Summary
 A stepwise approach to pharmacologic
therapy is recommended. The aim is to
accomplish the goals of therapy with the
least possible medication
 The availability of varying forms of
treatment, cultural preferences, and
differing health care systems need to be
considered
© Global Initiative for Asthma
http://www.ginasthma.org
© Global Initiative for Asthma