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    Whats New in GINA 2016

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    Alexandro Ivan Cahyadi
    The document summarizes the key changes in the 2016 Global Initiative for Asthma (GINA) strategy report. It outlines updates to the stepwise treatment approach, including new medication options. It also discusses management of asthma in low-resource settings and primary prevention strategies.

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    Whats New in GINA 2016

    Uploaded by

    Alexandro Ivan Cahyadi
    538 views9 pages
    The document summarizes the key changes in the 2016 Global Initiative for Asthma (GINA) strategy report. It outlines updates to the stepwise treatment approach, including new medication options. It also discusses management of asthma in low-resource settings and primary prevention strategies.

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    The document summarizes the key changes in the 2016 Global Initiative for Asthma (GINA) strategy report. It outlines updates to the stepwise treatment approach, including new medication options. It also discusses management of asthma in low-resource settings and primary prevention strategies.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    538 views9 pages

    Whats New in GINA 2016

    Uploaded by

    Alexandro Ivan Cahyadi
    The document summarizes the key changes in the 2016 Global Initiative for Asthma (GINA) strategy report. It outlines updates to the stepwise treatment approach, including new medication options. It also discusses management of asthma in low-resource settings and primary prevention strategies.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 9

    Global Initiative for Asthma (GINA)

    Whats new in GINA 2016?

    GINA Global Strategy for Asthma


    Management and Prevention
    Global Initiative for Asthma

    Stepwise treatment for adults and adolescents

    Step 3
    Low-dose fluticasone furoate/vilanterol an option for Step 3

    Step 4
    Tiotropium now an add-on option for adolescents (age 12 years) as well
    as adults, with a history of exacerbations

    Step 5: refer for expert investigation and add-on treatment, such as:
    Add-on tiotropium by mist inhaler for patients age 12 years with a history
    of exacerbations
    Add-on omalizumab (anti-IgE) for severe allergic asthma
    Add-on mepolizumab (anti-IL5) for severe eosinophilic asthma (12 years)
    Sputum-guided treatment, if available

    Low, medium and high ICS doses


    Fluticasone furoate: 100mcg (low dose); 200mcg (high dose)

    Stepping down ICS when asthma well-controlled now Evidence A


    (Hagan et al, Allergy 2014)

    Whats new in GINA 2016

    Global Initiative for Asthma

    GINA 2016 changes to Step 5

    STEP 5
    STEP 4
    PREFERRED
    CONTROLLER
    CHOICE

    STEP 1

    STEP 2

    Low dose ICS


    Other
    controller
    options
    RELIEVER

    Consider low
    dose ICS

    Leukotriene receptor antagonists (LTRA)


    Low dose theophylline*

    As-needed short-acting beta2-agonist (SABA)

    STEP 3

    Low dose
    ICS/LABA**

    Med/high
    ICS/LABA

    Med/high dose ICS Add tiotropium*


    Low dose ICS+LTRA High dose ICS
    + LTRA
    (or + theoph*)
    (or + theoph*)

    Refer for
    add-on
    treatment
    e.g.
    tiotropium*
    omalizumab
    mepolizumab*

    Add low
    dose OCS

    As-needed SABA or
    low dose ICS/formoterol#

    *Not for children <12 years. **For children 611 years, the preferred Step 3 treatment is medium dose ICS.
    # Low dose ICS/formoterol is the reliever medication for patients prescribed low dose budesonide/formoterol or low dose
    beclometasone/formoterol for maintenance and reliever therapy.

    Tiotropium by mist inhaler is an add-on treatment for patients with a history of exacerbations (not for children <12 years)
    .

    GINA 2016, Box 3-5, Step 5

    Global Initiative for Asthma

    Management of asthma in low-resource settings

    Where?
    Low-resource settings may be found not only in low and middle income
    countries (LMIC), but also in affluent nations

    Diagnosis in low-resource settings


    Up to 50% asthma undiagnosed, up to 34% over-diagnosed (Jos 2014)
    Ask about symptoms suggestive of chronic respiratory infections e.g. TB
    Peak flow meters recommended by WHO as essential tools for Package of
    Essential Non-communicable Diseases Interventions (WHO-PEN)

    Management of asthma in low-resource settings


    GINA strategy for stepwise treatment includes options for low-resource
    settings
    Prioritize the most cost-effective approach; include ICS and SABA
    Build capacity of primary health care teams, including nurses and
    pharmacist
    WHO-PEN recommends inclusion of peak flow meters as essential tools,
    and oximeters if resources permit

    Whats new in GINA 2016

    Global Initiative for Asthma

    Primary prevention of asthma (GINA Chapter 7)

    Maternal diet in pregnancy


    No firm evidence that ingestion of any specific foods in pregnancy
    increases risk for asthma
    Instead, maternal intake of foods commonly considered allergenic (peanut,
    milk) is associated with a decrease in allergy and asthma in offspring
    (Bunyavanich et al, JACI 2014; Maslova et al, JACI 2012, 2013)

    Therefore, no dietary changes are recommended during pregnancy for


    prevention of allergies or asthma

    Maternal obesity in pregnancy


    Maternal obesity and maternal weight gain in pregnancy are associated
    with an increased risk for asthma in children (Forno et al, Pediatrics 2014)
    However, no recommendations can be made at present, as unguided
    weight loss in pregnancy should not be encouraged

    Dampness and mold


    For children at risk of asthma, dampness, visible mold and mold odor in the
    home are associated with increased risk of developing asthma (Quansah et
    al, PLoS ONE 2012)

    Whats new in GINA 2016

    Global Initiative for Asthma

    Other changes in GINA 2016

    Non-pharmacological strategies for people with asthma


    Remediation of dampness or mold in homes reduces asthma symptoms
    and medication use in adults (Evidence A) (Sauni et al, Cochrane 2015)

    Other therapies
    In randomized controlled trials, Vitamin D supplementation has not been
    associated with improvement in asthma symptom control or reduction in
    exacerbations
    This statement was included in the GINA report because there had been wide
    expectation from cross-sectional studies that Vitamin D supplementation would
    be beneficial for asthma control

    Sections on allergen immunotherapy, vaccinations and bronchial


    thermoplasty have been included in the main report (previously only in
    Appendix)

    Methodology
    More details provided about GINA methodology, including the number of
    articles identified at each step

    Whats new in GINA 2016

    Global Initiative for Asthma

    Peer-reviewed articles about GINA

    GINA 2014: a global asthma strategy for a global problem


    Reddel HK et al. Int J Tuberc Lung Dis 2014; 18: 505-6 (free full text)
    Emphasizing the distinction between population-level and individualized
    patient-level decisions

    The revised 2014 GINA strategy report: opportunities for change


    Boulet LP et al. Curr Opin Pulm Med 2015; 21: 1-7
    Describes the context that prompted key changes in the GINA report

    The GINA asthma strategy report: what's new for primary care?
    Reddel HK, Levy ML. NPJ Prim Care Respir Med 2015; 25: 15050
    (free full text)
    Summary of key changes in the GINA report for primary care

    A summary of the new GINA strategy: a roadmap to asthma control


    Reddel HK et al. Eur Respir J 2015; 46: 622-39 (free full text)
    Summarizes key changes in GINA 2014-15, with their rationale
    We recommend that this article should be read as a companion piece to
    the GINA report itself

    Whats new in GINA 2016

    Global Initiative for Asthma

    GINA eBooks

    GINA 2016 Pocket Guide eBook now available on Amazon

    Whats new in GINA 2016

    Global Initiative for Asthma

    www.ginasthma.org

    GINA Global Strategy for Asthma


    Management and Prevention
    Global Initiative for Asthma

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