Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes
The document that ended fifty years of short-acting beta agonist monotherapy. GINA no longer recommends a reliever inhaler alone at any step of asthma treatment: every adult and adolescent should carry an inhaled corticosteroid, either in the reliever itself as budesonide-formoterol taken as needed, or as a daily controller alongside a separate reliever. The reasoning is that a patient who feels better after a puff of salbutamol has treated the symptom and not the inflammation, and that the risk of a severe exacerbation, and of death, tracks reliever use. Track 1, with as-needed budesonide-formoterol, is named the preferred approach because it is the one that reduces severe exacerbations without asking a well-feeling patient to take a daily drug. The register's trials behind that reversal are below.
This guideline cites 2 of the 35 landmark trials in our Pulmonology register.