A new ‘roadmap to asthma control’ focuses on how to implement the guidelines of the Global Initiative for Asthma (GINA), aiming to be “less like a textbook and more like a practical manual”.
Associate Professor Helen Reddel, of the Woolcock Institute of Medical Research at the University of Sydney and chair of the GINA Scientific Committee, told the limbic that the changes introduced in the major 2014 revision and a 2015 update of GINA’s global strategy include a new definition of asthma.
“It’s designed to assist in diagnosis of patients with respiratory symptoms in clinical practice and to highlight the heterogeneity of asthma,” she said.
The definition is an ‘umbrella’ term consistent with a need to individualise patients’ management according to the biological features of their disease and behavioural, social and cultural factors.
The new guidelines also use the term ‘flare-up’ instead of ‘exacerbation’, as part of a strategy to improve communication with patients who often did not understand the meaning of an ‘exacerbation’.
Other changes introduced in the GINA report, summarised in a paper in the European Respiratory Journal and highlighted by Professor Reddel, include a framework for tailoring treatment across the whole spectrum of asthma, not just in severe asthma.
“This includes checking for modifiable risk factors and checking inhaler technique and adherence, before considering any treatment step-up,” she says.
“There are also expanded indications for starting preventer treatment in mild asthma and revised recommendations about written asthma action plans.”
The major GINA revision published in 2014 provided the basis for many of the recommendations in the new Australian asthma guidelines (www.asthmahandbook.org.au), also published in 2014, she says.
There are some differences between the two sets of guidelines.
“The GINA report includes a full chapter on diagnosis and management of patients with features of both asthma and COPD, reflecting a concept that these patients have similar clinical features that may be caused by several different underlying mechanisms,” Professor Reddel says.
“In contrast, the concept of asthma-COPD overlap described in the Australian Asthma Handbook is of two co-existing but separate conditions. This is not necessarily helpful for clinicians, as some recommendations in current Australian asthma and COPD guidelines are in direct conflict. For example, treatment with LABA alone without ICS is contraindicated for asthma but encouraged for mild COPD.”
Professor Reddel says the Australian Asthma Handbook is a more accessible online resource than the GINA report, with recommendations prioritised for actions in clinical practice and an intuitive search function.
“Another difference is that GINA has been funded independently from sales of its resources since 2014, while the National Asthma Council and the Australian asthma guidelines have substantial funding from industry, although a strong statement is made in the Handbook about editorial independence,” she says.
The GINA Science Committee routinely meets twice a year to review new evidence and publishes yearly updates.
“Policies and procedures for updating the Australian guidelines as new evidence emerges have not yet been described, but a minor update was published in April 2015,” she says.
“We know that the recommendations in Australian asthma guidelines are evidence-based, and consistent with international best practice.
“Clinicians should make sure that they are aware of the substantial changes in guidelines in the last 12 months, as many are relevant to their day to day clinical practice. We encourage clinicians to read the new asthma guidelines, as they are much more accessible than the past textbook-style approach.”