Following the symposium “Anti-IgE: changing lives in clinical practice?”, the Global Initiative for Asthma (GINA) guidelines were revised in November 2006 [1]. The GINA classification of asthma by severity based on clinical features is still considered useful when decisions are being made about management at the initial assessment of a patient. However, the GINA 2006 guidelines no longer recommend that treatment decisions are based on asthma severity classification, but that they should instead be based on the level of asthma control and current treatment.
According to the GINA 2006 guidelines, treatment should be tailored to each patient's asthma control and current treatment (step 1–5), with treatment progressing to the next step if control is not achieved [1]. Rapid-acting β2-agonists are recommended at step 1; low-dose inhaled corticosteroids and, if needed, long-acting β2-agonists are recommended at steps 2 and 3. Daily treatment with medium- or high-dose inhaled corticosteroids in combination with a long-acting β2-agonist is recommended at treatment step 4, with additional controller medication if needed (sustained-release theophyllines and/or leukotriene modifiers). Anti-immunoglobulin E (omalizumab) and oral corticosteroids are included at step 5 (fig. 1⇓).
Global Initiative for Asthma 2006 guidelines for asthma treatment in patients aged ≥5 yrs. ICS: inhaled corticosteroids; LABA: long-acting β2-agonist. Ig: immunoglobulin. #: receptor antagonist or synthesis inhibitor. Reproduced, with modifications, from [1] with permission from the publisher.
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