Review

. 2021 Dec 31;59(1):2102730.

doi: 10.1183/13993003.02730-2021. Print 2022 Jan.

Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes

Helen K Reddel¹, Leonard B Bacharier², Eric D Bateman³, Christopher E Brightling⁴, Guy G Brusselle^{5

6}, Roland Buhl⁷, Alvaro A Cruz⁸, Liesbeth Duijts⁹, Jeffrey M Drazen^{10

11}, J Mark FitzGerald¹², Louise J Fleming¹³, Hiromasa Inoue¹⁴, Fanny W Ko¹⁵, Jerry A Krishnan¹⁶, Mark L Levy¹⁷, Jiangtao Lin¹⁸, Kevin Mortimer^{19

20}, Paulo M Pitrez²¹, Aziz Sheikh²², Arzu A Yorgancioglu²³, Louis-Philippe Boulet^{24

25}

Affiliations

¹ The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia helen.reddel@sydney.edu.au.
² Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Dept of Medicine, University of Cape Town, Cape Town, South Africa.
⁴ Leicester National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, UK.
⁵ Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
⁶ Depts of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁷ Pulmonary Dept, Mainz University Hospital, Mainz, Germany.
⁸ Federal University of Bahia, Salvador, Brazil.
⁹ Dept of Pediatrics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
¹⁰ Divisions of Medical Communication and Pulmonary Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹¹ Harvard Medical School, Boston, MA, USA.
¹² University of British Columbia, Vancouver, BC, Canada.
¹³ Imperial College London, London, UK.
¹⁴ Kagoshima University, Kagoshima, Japan.
¹⁵ The Chinese University of Hong Kong, Hong Kong.
¹⁶ Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, USA.
¹⁷ Locum General Practitioner, London, UK.
¹⁸ China-Japan Friendship Hospital, Peking University, Beijing, China.
¹⁹ Dept of Respiratory Medicine, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, UK.
²⁰ Dept of Medicine, University of Cambridge, Cambridge, UK.
²¹ Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
²² Usher Institute, University of Edinburgh, Edinburgh, UK.
²³ Dept of Pulmonology, Celal Bayar University, Manisa, Turkey.
²⁴ Institut universitaire de cardiologie et de pneumologie de Québec, QC, Canada.
²⁵ Département de médecine, Université Laval, Québec, QC, Canada.

PMID: 34667060
PMCID: PMC8719459
DOI: 10.1183/13993003.02730-2021

Review

Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes

Helen K Reddel et al. Eur Respir J. 2021.

. 2021 Dec 31;59(1):2102730.

doi: 10.1183/13993003.02730-2021. Print 2022 Jan.

Authors

Affiliations

¹ The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia helen.reddel@sydney.edu.au.
² Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Dept of Medicine, University of Cape Town, Cape Town, South Africa.
⁴ Leicester National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, UK.
⁵ Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
⁶ Depts of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁷ Pulmonary Dept, Mainz University Hospital, Mainz, Germany.
⁸ Federal University of Bahia, Salvador, Brazil.
⁹ Dept of Pediatrics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
¹⁰ Divisions of Medical Communication and Pulmonary Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹¹ Harvard Medical School, Boston, MA, USA.
¹² University of British Columbia, Vancouver, BC, Canada.
¹³ Imperial College London, London, UK.
¹⁴ Kagoshima University, Kagoshima, Japan.
¹⁵ The Chinese University of Hong Kong, Hong Kong.
¹⁶ Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, USA.
¹⁷ Locum General Practitioner, London, UK.
¹⁸ China-Japan Friendship Hospital, Peking University, Beijing, China.
¹⁹ Dept of Respiratory Medicine, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, UK.
²⁰ Dept of Medicine, University of Cambridge, Cambridge, UK.
²¹ Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
²² Usher Institute, University of Edinburgh, Edinburgh, UK.
²³ Dept of Pulmonology, Celal Bayar University, Manisa, Turkey.
²⁴ Institut universitaire de cardiologie et de pneumologie de Québec, QC, Canada.
²⁵ Département de médecine, Université Laval, Québec, QC, Canada.

PMID: 34667060
PMCID: PMC8719459
DOI: 10.1183/13993003.02730-2021

Abstract

The GINA Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention. This article summarizes key recommendations from GINA 2021, and the evidence underpinning the new changes. https://bit.ly/3FZblIS

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: L.B. Bacharier reports receiving royalties for textbooks from Elsevier; consulting fees from GlaxoSmithKline, Teva, AstraZeneca, Sanofi, Regeneron, Vectura, Circassia, Kinaset, Merck and Boehringer Ingelheim; honoraria for lectures from GlaxoSmithKline, Genentech/Novartis, Teva Honoraria, AstraZeneca, Sanofi/Regeneron and WebMD/Medscape; participation on a data safety monitoring board or advisory board for DBV Technologies, AstraZeneca and Vertex (CF Foundation); leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid for AAAAI Board of Directors (unpaid) and ABAI Board of Directors, in the past 36 months. E.D. Bateman reports receiving advisory board, consultant and speaker fees from AstraZeneca, Sanofi Genzyme, Regeneron, Novartis and ALK; speaker fees from Boehringer Ingelheim, Menarini and Orion; and advisory board and speaker fees from Chiesi, since the initial planning of this work; E.D. Bateman reports receiving consulting fees from AstraZeneca, Sanofi Genzyme, Regeneron, Novartis and ALK; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Menarini, Orion, Novartis, Regeneron, Sanofi Genzyme, Chiesi and ALK; support for attending meetings and/or travel from Novartis (to attend European Respiratory Society Congress 2021); participation on a data safety monitoring board or advisory board from AstraZeneca, ALK, Sanofi Genzyme, Regeneron, Novartis and Chiesi; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid for Global Initiative for Asthma (Member of Board and Science Committee, unpaid), in the past 36 months. L-P. Boulet reports grants paid to institution for multicentre or investigator-generated clinical studies from Amgen, AstraZeneca, GlaxoSmithKline, Merck, Novartis and Sanofi-Regeneron; royalties from UpToDate; consultancy fees from AstraZeneca, Novartis, GlaxoSmithKline, Merck and Sanofi-Regeneron; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Covis, GlaxoSmithKline, Novartis, Merck and Sanofi; and is Chair of the Global Initiative for Asthma (GINA) Board of Directors, President of the Global Asthma Organisation (Interasma), member of the Canadian Thoracic Society Respiratory Guidelines Committee, and Laval University Chair on Knowledge Transfer, Prevention and Education in Respiratory and Cardiovascular Health. C.E. Brightling reports receiving grants or contracts from GSK, AZ, Novartis, Chiesi, BI, Mologic, 4DPharma, Gossamer, Merck and Roche/Genentech (all paid to institution); consulting fees from AZ, Novartis, Chiesi, BI, Mologic, TEVA, 4DPharma, Gossamer, Regeneron, Sanofi and Roche/Genentech (all paid to institution), in the past 36 months. G.G. Brusselle reports receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi and Teva; participation on a data safety monitoring board or advisory board for AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, MSD, Novartis, Sanofi and Teva, in the past 36 months. R. Buhl reports grants from Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Roche; lecture honoraria from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Novartis, Roche, Sanofi, Teva; participation on advisory board from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Roche, Sanofi, Teva; outside the submitted work; and has acted as a Member of the Scientific Committee of the Global Initiative for Asthma (GINA). A.A. Cruz reports lecture honoraria from Abdi Ibrahim, AstraZeneca, Boehringer Ingelheim, Chiesi, Glennmark, GSK, Mylan, Novartis and Sanofi; travel support from AstraZeneca, Boehringer Ingelheim and Chiesi, outside the submitted work. L. Duijts reports grants from European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement number 733206, 2016; EUCAN-Connect grant agreement number 824989; ATHLETE, grant agreement number 874583), outside the submitted work. J.M. FitzGerald reports grants from AstraZeneca, GSK, TEVA, Sanofi, CIHR and NIH; consulting fees and lecture honoraria from AstraZeneca, GSK, TEVA and Sanofi; outside the submitted work. L.J. Fleming reports consulting fees from GSK, Sanofi, Respiri UK and AstraZeneca; lecture honoraria from Novartis and Teva, outside the submitted work. H. Inoue reports grants to institution from Boehringer Ingelheim, GlaxoSmithKline, Kyorin, MerckSharp&Dohme and Ono; personal consulting fees from Boehringer Ingelheim; lecture honoraria from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Kyorin, MerckSharp&Dohme, Novartis and Sanofi; has participated on an advisory board for AstraZeneca, GlaxoSmithKline, Novartis and Sanofi; board leadership with Japanese Respiratory Society (Board of Directors and Chairman of Education Committee) and Japanese Society of Allergology (Former Chairman of Education Committee), outside the submitted work. F.W. Ko reports support for travel from Novartis, Boehringer Ingelheim and GSK, outside the submitted work. J.A. Krishnan reports grants from Regeneron Pharmaceuticals, Sergey Brin Family Foundation, Patient Centered Outcomes Research Institute, COPD Foundation and American Lung Association; consulting fees from GlaxoSmithKline for COVID-19 mAb; board leadership at COPD Foundation and Respiratory Health Association, outside the submitted work. M.L. Levy reports grants from Consorzio Futuro in Ricerca and AstraZeneca; royalties from Class Publishing and Taylor & Francis; consulting fees from Respiri, Ltd, TEVA and NSHI Ltd; lecture honoraria from TEVA, Novartis, Chiesi and Orion; payment for expert testimony from HM Coroner Walthamstow, London, and HM Coroner, Waltham Forrest, London; travel support from Orion Pharmaceuticals, Menarini Pharmaceuticals, Napp Pharmaceuticals and TEVA; participation on advisory board at Chiesi, Novartis, GSK and Sandoz; and board leadership at GINA (Board of Directors), outside the submitted work. K. Mortimer has participated as member of advisory boards for AstraZeneca, outside the submitted work. P.M. Pitrez reports consulting fees and lecture honoraria from AstraZeneca, Boehringer Ingelheim, GSK, Sanofi and Novartis; travel support from GSK and Boehringer Ingelheim; and held an unpaid position as President of the Brazilian Severe Asthma Group, outside the submitted work. H.K. Reddel reports grants from AstraZeneca, GlaxoSmithKline and Novartis; consulting fees from Novartis; lecture payments from AstraZeneca, GlaxoSmithKline, Teva, Boehringer Ingelheim, Sanofi and Chiesi; participation on advisory boards for AstraZeneca, GlaxoSmithKline, Novartis, Chiesi and Sanofi; acted as Chair of Scientific Committee and Member of Board of Directors for Global Initiative for Asthma, and acted as Member of Australian Asthma Guidelines Committee for National Asthma Council, outside the submitted work. A. Sheikh reports grants from HDRUK BREATHE Hub, and Asthma UK Centre for Applied Research; and participated in the AstraZeneca Unmet Asthma Need Working Group; outside the submitted work. A.A. Yorgancioglu reports grants from MSD, AstraZeneca, Sanofi and Novartis; consulting fees from AstraZeneca, GSK, Novartis, Sanofi, Chiesi and Deva; lecture honoraria from AstraZeneca, Abdi İbrahim, GSK, Novartis, Sandoz, Chiesi and Vem İlaç; advisory board participation from GSK and AstraZeneca; outside the submitted work. All other authors have nothing to disclose.

Figures

**FIGURE 1**
Global Initiative for Asthma assessment of asthma control in adults, adolescents, and children 6–11 years. For a version of this figure with full reference citations, please see box 2-2 in reference . P450 inhibitors include cytochrome P450 inhibitors such as ritonavir, ketoconazole, and itraconazole. *: based on SABA (as-needed ICS–formoterol reliever not included); excludes reliever taken before exercise. For children 6–11 years, see also box 2-3 in reference . For specific risk reduction strategies, see box 3-8 in reference . ^†: “independent” risk factors are those that are significant after adjustment for the level of symptom control. Reproduced by permission from reference (box 2-2). BD: bronchodilator; F_eNO: fractional exhaled nitric oxide; GERD: gastroesophageal reflux disease; ICS: inhaled corticosteroid; OCS: oral corticosteroid; SABA: short-acting β₂-agonist.

**FIGURE 2**
Personalized asthma management cycle of care. Reproduced by permission from reference (box 3-2).

**FIGURE 3**
Personalized management for adults and adolescents to control symptoms and minimize risk. For ICS doses, see box 3–6 in reference . Reproduced by permission from reference (box 3-5A). HDM: house dust mite; ICS: inhaled corticosteroid; LABA: long-acting β₂-agonist; LAMA: long-acting muscarinic antagonist; LTRA: leukotriene receptor antagonist; OCS: oral corticosteroid; SABA: short-acting β₂-agonist; SLIT: sublingual immunotherapy.

**FIGURE 4**
Personalized management for children 6–11 years to control symptoms and minimize future risk. For ICS doses for children, see box 3-6 in reference . For MART doses, see table E2 and the downloadable resource in the supplementary material. Reproduced by permission from reference (box 3-5B). BUD-FORM: budesonide–formoterol; ICS: inhaled corticosteroid; LABA: long-acting β₂-agonist; LTRA: leukotriene receptor antagonist; MART: maintenance-and-reliever therapy; OCS: oral corticosteroid; SABA: short-acting β₂-agonist.

**FIGURE 5**
Management of asthma exacerbations in primary care (adults, adolescents, children 6–11 years). SABA doses are for albuterol. Reproduced by permission from reference (box 4-3). PEF: peak expiratory flow; pMDI: pressurized metered-dose inhaler; SABA: short-acting β₂-agonist.

**FIGURE 6**
Personalized management of asthma in children 5 years and younger. Reproduced by permission from reference (box 6-5). ICS: inhaled corticosteroid; LTRA: leukotriene receptor antagonist; SABA: short-acting β₂-agonist.

See this image and copyright information in PMC

References

1. Global Asthma Network . The Global Asthma Report 2018. Auckland, Global Asthma Network, 2018. http://globalasthmareport.org (Last accessed Sept 2021).
1. National Heart, Lung, and Blood Institute National Asthma Education and Prevention Program; World Health Organization . Global Initiative for Asthma . Bethesda, National Institutes of Health; 1995. National Institutes of Health Publication number 95-3659.
1. Global Initiative for Asthma . Methodology. Fontana, Global Initiative for Asthma, 2021. https://ginasthma.org/about-us/methodology (Last accessed Sept 2021).
1. Global Initiative for Asthma . Global Strategy for Asthma Management and Prevention. Fontana, Global Initiative for Asthma, 2021. www.ginasthma.org/reports (Last accessed Sept 2021).
1. Aaron SD, Vandemheen KL, FitzGerald JM, et al. . Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA 2017; 317: 269–279. doi:10.1001/jama.2016.19627 - DOI - PubMed

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Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes

Affiliations

Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes

Authors

Affiliations

Abstract

Conflict of interest statement

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