The GINA guidelines were updated in 2022.
There is more emphasis on making the diagnosis of asthma before initiation of treatment based on variability in Forced Expiratory Volume in 1second (FEV1) or peak expiratory flow rate(PEFR). If treatment has been started and variability is not demonstrated, spirometry can be repeated after withholding treatment.
It recommends the term ‘mild asthma’ should generally be avoided in clinical practice and warns about the risks of severe exacerbations and the need for regular ICS containing treatment.
There was also increased emphasis on using combination – inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) - treatment as maintenance and reliever therapy (MART). A separate track was added to emphasize superiority over using short-acting beta-agonists (SABA) as reliever. More studies showing reduction in severe exacerbations, and/or hospital visits and admissions were presented as evidence for the superiority of combination treatment as reliever in mild asthma.
Long-acting muscarinic antagonists (LAMA) were not recommended. Cromones have been discontinued.
New biologics have been added to Step 5 options in severe eosinophilic and Type 2 asthma.
Asthma action plans should be written (printed, digital and/or pictorial) rather than just verbal.
Children less than 5-years-old with intermittent viral wheezing may be treated with intermittent short courses of ICS.