单位：[1]TheWoolcock Institute of Medical Research and The University of Sydney, Sydney, Australia[2]Monroe Carell Jr. Children’s Hospital atVanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee[3]Department of Medicine, University of Cape Town, CapeTown, South Africa[4]Leicester National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester,United Kingdom[5]Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium[6]Departments of Epidemiology andRespiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands[7]PulmonaryDepartment, Mainz University Hospital, Mainz, Germany[8]Federal University of Bahia, Salvador, Bahia, Brazil[9]Department ofPediatrics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands[10]Divisions of MedicalCommunication and Pulmonary Medicine, Department of Medicine, Brigham andWoman’s Hospital, Boston, Massachusetts[11]Harvard Medical School, Boston, Massachusetts[12]University of British Columbia, Vancouver, British Columbia, Canada[13]ImperialCollege London, London, United Kingdom[14]Kagoshima University, Kagoshima, Japan[15]The Chinese University of Hong Kong, HongKong[16]Breathe Chicago Center, University of Illinois Chicago, Chicago, Illinois[17]Locum General Practitioner, London, UnitedKingdom[18]China–Japan Friendship Hospital, Peking University, Beijing, China[19]Department of Respiratory Medicine, LiverpoolUniversity Hospitals National Health Service Foundation Trust, United Kingdom[20]Department of Medicine, University of Cambridge,Cambridge, United Kingdom[21]Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil[22]Usher Institute, University of Edinburgh, Edinburgh, United Kingdom[23]Department of Pulmonology, Celal Bayar University, Manisa,Turkey[24]Institut universitaire de cardiologie et de pneumologie de Quebec[25]Departement de medecine, Universite Laval,Quebec, Quebec, Canada
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting beta(2)-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by >60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting beta(2)-agonist (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.
第一作者单位：[1]TheWoolcock Institute of Medical Research and The University of Sydney, Sydney, Australia[*1]Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia
通讯作者：
通讯机构：[1]TheWoolcock Institute of Medical Research and The University of Sydney, Sydney, Australia[*1]Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia
推荐引用方式(GB/T 7714)：
Helen K. Reddel,Leonard B. Bacharier,Eric D. Bateman,et al.Global Initiative for Asthma Strategy 2021 Executive Summary and Rationale for Key Changes[J].AMERICAN JOURNAL of RESPIRATORY and CRITICAL CARE MEDICINE.2022,205(1):17-+.doi:10.1164/rccm.202109-2205PP.
APA：
Helen K. Reddel,Leonard B. Bacharier,Eric D. Bateman,Christopher E. Brightling,Guy G. Brusselle...&Louis-Philippe Boulet.(2022).Global Initiative for Asthma Strategy 2021 Executive Summary and Rationale for Key Changes.AMERICAN JOURNAL of RESPIRATORY and CRITICAL CARE MEDICINE,205,(1)
MLA：
Helen K. Reddel,et al."Global Initiative for Asthma Strategy 2021 Executive Summary and Rationale for Key Changes".AMERICAN JOURNAL of RESPIRATORY and CRITICAL CARE MEDICINE 205..1(2022):17-+
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