GINA 2025: Key Updates for Asthma Management in Adults, Adolescents, and Children

 

The Global Initiative for Asthma (GINA) has released its 2025 update to the Global Strategy for Asthma Management and Prevention.

Biomarkers of Type 2 Inflammation:

GINA 2025 collates and expands information on Type 2 biomarkers like blood eosinophils and fractional exhaled nitric oxide (FeNO) in asthma diagnosis, assessment, and management. This information is now available as a new resource (Appendix A). Importantly, the update emphasizes the significant circadian variability in both blood eosinophils and FeNO, highlighting the need for caution when comparing patient results with absolute thresholds and the relevance of assessing adherence before considering biologic therapy.

Severe Exacerbation Risk Factors:

The ORACLE2 study reinforces GINA's recommendation to consider multiple factors, including Type 2 biomarkers, when assessing future exacerbation risk. SABA overuse could not be assessed in this study; however, real-world data analysis on SABA use is needed. GINA also highlights the significant impact of extreme weather events on asthma exacerbations and the need for urgent care.

Diagnosis in Young Children:

GINA 2025 provides a revised approach to diagnosing asthma in children aged 5 years and younger. The update confirms the possibility of diagnosis in this age group, emphasizing three key criteria: (1) recurrent acute wheezing episodes with or without interval asthma-like symptoms; (2) unlikely alternative diagnoses; and (3) timely clinical response to asthma treatment.

Treatment in Young Children:

Updates for treatment in children aged 5 years and younger focus on diagnosed asthma. The treatment figure is revised based on current evidence for efficacy, effectiveness, and safety.

Diagnosis and Treatment in Adults and Adolescents:

The diagnostic flowchart is clarified, emphasizing variability in symptoms and expiratory airflow as key features of asthma. The update recommends against using the term "mild asthma" due to its ambiguity and potential for misinterpretation. Instead, GINA encourages assessing symptom control and risk factors, prioritizing ICS-containing therapy from the time of diagnosis. Changes in Track 2, Step 4, aim to minimize exposure to high-dose ICS.

Non-recommended Bronchodilators: Fenoterol is added to the list of non-recommended bronchodilators due to its higher risk of cardiovascular adverse effects and asthma mortality.

Shared Decision-Making for Inhaler Choice: The "flower figure" (Box 5-1) illustrating shared decision-making is redesigned to emphasize the order in which factors should be considered, prioritizing the patient's needs and medication effectiveness before considering environmental impact.

Action Plans: Action plan guidance is reorganized by treatment Track to reflect the different approach depending on reliever type. The update reinforces increasing as-needed ICS-formoterol in Track 1 for better exacerbation control and clarifies the limited evidence for increasing ICS in Track 2 action plans.

 

Access the Full Report:

For comprehensive information, please refer to the full GINA 2025 report. Note: this newsletter summarizes key changes. Consult the complete guidelines for detailed recommendations and evidence.