Now Available: GINA 2025

The GINA Strategy Report has been updated following the routine twice-yearly cumulative review of the literature by the GINA Science Committee, and extensive discussion about issues relevant to clinical practice and research.

• Biomarkers of Type 2 inflammation– information about the role of Type 2 biomarkers (particularly blood eosinophils and fractional exhaled nitric oxide [FeNO]) in the diagnosis, assessment and management of asthma has been collated in Appendix A (pg 217). Factors contributing to variability in blood eosinophil count and FeNO, including marked circadian (opposite) variability of both blood eosinophils and FeNO has been added. This information is highly relevant when clinicians are assessing a patient’s eligibility for Type 2-targeted biologic therapy; it also indicates that caution is needed when comparing a patient’s biomarker results with absolute thresholds in clinical practice.
• Risk factors for severe exacerbations in adults and adolescents: multiple factors, including Type 2 biomarkers, should be considered in the assessment of patients’ risk of future exacerbations (Box 2-2B, pg 37)
• Impact of extreme weather: A new section has been added about the impact of climate change and extreme weather on people with asthma. Extreme heat and extreme cold are both associated with an increased risk of asthma exacerbations and need for urgent care.
• Diagnosis and treatment of management of asthma in children aged 5 years and younger: Section 10 (pg 181) underwent extensive review and revision. Most important change is the confirmation that the diagnosis of asthma can be made in this age-group. Box 10-1 (pg 181 and Box 10-2 (pg 182) outline an approach to diagnosis with three clinical criteria that can be summarized as:
  • Recurrent episodes of wheezing with or without interval asthma-like symptoms
  • Assessment that an alternative is unlikely to be causing the symptoms or signs
  • A timely response to asthma treatment, including symptomatic improvement within minutes after administration of SABA (in a healthcare setting or at home) or during a diagnostic trial with daily ICS plus as-needed SABA for 2-3 months.
  • Future state? Several studies of anti-reliever therapy with low-dose ICS-formoterol in children are underway, including in children aged 5 years and younger.
• Diagnosis of asthma in adults and adolescents: clarifies that airflow limitation does not need to be present at the time of diagnostic assessment.
• Personalized asthma care: the consideration of biomarkers including FeNO has been added to the Review section of the cycle of Assess- Adjust- Review.
• Action Plans: Box 9-2, page 163. For patients using SMART (Track 1), the patient continues to taking their usual maintenance dose, but increases their as-needed doses incrementally to achieve control of increasing inflammation and bronchoconstriction. There is strong evidence for significant reduction in the risk of severe exacerbations needing OCS, and needing urgent health care.
• Treatment of severe exacerbations in adults, adolescents and children 6-11 years: doses of SABA for initial treatment in primary and emergency departments have been clarified to avoid excessive use.
• Severe asthma decision tree: Confirmation of the diagnosis of severe asthma has been moved to stage 5, after the initial specialist assessment. Prompt added to re-evaluate previously low blood eosinophils and/or FeNO if the clinical context changes.