The Global Initiative for
Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for
asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that
asthma in adults and adolescents should not be treated solely with short-acting β2-agonist (
SABA), because of the risks of
SABA-only treatment and
SABA overuse, and evidence for benefit of inhaled
corticosteroids (ICS). Large trials show that as-needed combination ICS-
formoterol reduces severe exacerbations by ≥60% in mild
asthma compared with
SABA alone, with similar
exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed
SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-
formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild
asthma), and with daily maintenance ICS-
formoterol (maintenance-and-reliever
therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed
SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting β2-agonist (Steps 3-5). For adults with moderate-to-severe
asthma, GINA makes additional recommendations in Step 5 for add-on long-acting
muscarinic antagonists and
azithromycin, with add-on
biologic therapies for severe
asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize
asthma outcomes.