[mdphd] Update: Asthma Guidelines (GINA 2019)

[Alan Blayney]

Happy Monday Everyone,
The latest issue of the Canadian Medical Association Journal highlighted
updated 2019 asthma treatment guidelines from the Global Initiative for
Asthma (GINA), which propose a dramatically different approach to the
treatment of mild asthma. Specifically, they found an increased risk of
asthma-related death in adolescent/adult patients with intermittent/mild
asthma who used a SABA-only relief inhaler more than once per month with no
ICS. The new GINA recommendation is to no longer offer SABA-only relief
inhalers to adolescents and adults, and instead prescribe ICS+LABA relief
inhalers, which they state are also non-inferior to daily ICS in mild
asthma. It appears that ICS+SABA relief treatment as an alternative has not
been studied, since much of this was driven by the development of a
budesonide-formoterol inhaler.
My talk was based on US (NAEPP) guidelines, which were last updated in
2007. They are currently under review (working group established in 2018),
and so will likely publish a position on this by the time most of us reach
the clinic.
Best,
~   Alan
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