0531. GINA, the Global Initiative for Asthma

GINA, launched in 1993 as an NIH-WHO initiative, has been part of the drive to shift mindsets and foster recognition that asthma is not simply reactive airway disease but is an inflammatory disease with airway remodeling as a significant risk factor. The implication is that patients should have appropriate access to anti-inflammatories (i.e. steroids); however, given a fairly common reluctance of paediatricians to commit children to long-term maintenance therapy, it is not surprising that milder asthmatics who respond well to intermittent dilators are treated only with the latter. GINA guidelines target airway remodeling and achievement of normal lung function, and investigators have addressed the question of changes in groups of patients with clinically more-severe disease treated with maintenance steroids vs milder disease treated only with intermittent steroids. In one study the percentage of children with airway remodeling over 5 years (as defined by the FEV1/FVC ratio post-bronchodilator) increased in the milder (steroid-untreated) group vs a decrease in the more severe (steroid-treated) group. In the second study, which was more invasive and subjected subjects to bronchial biopsy, the thickness of the epithelial reticular basement membrane was greater in mild (steroid-untreated) subjects than in more-severe patients on maintenance steroids. The message is that reluctance to use steroids in the milder cases can disadvantage patients in the long term, and the recommendation is that children with mild intermittent asthma should undergo regular pulmonary function testing. If any deterioration is detected in the FEV1/FVC ratio then preventive steroid treatment should be initiated.

Read more:
GINA: www.ginasthma.com
Chest 2002;122:1622-6
Respir Med 2005; Epub (Pubmed)