Dr Megan Althoff: Updated GINA Guidelines Include Reliever Treatment With an Inhaled Corticosteroid

The 2019/2020 Global Initiative for Asthma (GINA) guidelines recommend formoterol, a long-acting beta agonist/inhaled steroid, to produce better long-term outcomes in patients, noted Megan Althoff, MD, PhD, second-year fellow, University of Colorado, Division of Pulmonary Sciences and Critical Care Medicine.

Transcript

How has the treatment paradigm of asthma shifted across disease severities?

The paradigm shift that that was referencing actually refers to the change that was made in the GINA 2019/2020 guidelines that they're no longer recommending a short-acting beta agonist like albuterol. For reliever therapy, rather, they're recommending an ICS [inhaled corticosteroid], formoterol, which is the long-acting beta agonist that has a quick onset.

The data behind that, there were a couple really large, really well-done clinical trials published in the New England Journal of Medicine in 2018, the SYGMA trials, and those basically show similar outcomes between patients treated with a maintenance inhaled corticosteroid versus patients who were just on the reliever option budesonide/formoterol included in that study. So that paired with the data that we know, there's a lot of mild, intermittent asthmatics who are only on albuterol, or short-acting beta agonists, who still can have really poor outcomes. And we can see this with escalating use of albuterol over time, or in a given year. They tend to have poor outcomes. And so the thought is that if we can treat them with some sort of inhaled steroid as well, potentially you get better outcomes in long term in them.

So that’s the big paradigm shift. And then really because there's other more recent guidelines, and we've had more biologics approved, they are guidelines for when they think you would be successful in