Table Info

Table 1.

Examples of local asthma guidelines and their modifications in contrast to GINA changes, if any

Guidelines	Country	Latest update	Measure of asthma severity	Implemented new GINA changes	Presence of the preferred track	Start with inhaled corticosteroids (ICS)/formoterol as needed PRN for mild intermittent asthma	Short-acting β2-agonists (SABA) alone as an option in mild intermittent asthma	Maintenance-and-reliever therapy (MART) as an option in any step	ICS for mild persistent asthma
GINA [1]	Global	2022	Symptoms	N/A	Yes	Yes	No	Yes	Alternative option
BTS/SIGN [4]	UK	2019	Symptoms plus exacerbation history in the past 2 years	No	No	No	Yes	Yes	Preferred
Saudi Initiative for Asthma (SINA) [6]	Saudi Arabia	2021	Asthma Control Test (ACT)	Yes	No (although ICS to be given when SABA is used as needed is considered as an alternative option)	Yes	No	Yes	Yes
Ministry of Health Asthma Pocket Guide for health care professionals [21]	Saudi Arabia	2020	ACT symptoms	Yes	No, but clear recommendation to use ICS/formoterol as the first choice and alternative use of ICS whenever SABA used	Yes	No	Yes	No (use ICS/formoterol)
Manejo Integral del Asma (MIA), Comprehensive Asthma Management Guidelines for Mexico [7]	Mexico	2021	Symptoms plus exacerbation and hospitalization	Yes	Yes	Yes	No	Yes	Yes
Spanish Asthma Management Guidelines (GEMA) [9]	Spain, Portugal, and Latin America	2022	Symptoms and exacerbation	Partial	No	Yes	Yes	Not specifically	Preferred
Japanese guidelines for adult asthma [8]	Japan	2020	Symptoms and frequent exacerbation for severe persistent only	No	No	No	No (low dose ICS to be used regularly)	No	Preferred
Canadian Thoracic Society (CTS) [10]	Canada	2021	Symptoms, exacerbation, and inflammatory markers	No	No	Yes	Yes	Yes	Preferred
Qatar National Clinical Guidelines [5]	Qatar	2019	Symptoms	No	No	No (low dose ICS)	No	Yes	Preferred
Abu Dhabi Department of Health guidelines [2]	Abu Dhabi, United Arab Emirates (UAE)	2018	Symptoms	No	No	No	Yes	Yes, for steps 3 and 4	Low dose ICS
Dubai Department of Health guidelines [3]	Dubai, UAE	2018	Symptoms	No	No	No	Yes	Yes	Low dose ICS

N/A: not applicable

Declarations

Author contributions

RA and HALJ: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. Both authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

References

Global strategy for asthma management and prevention (2022 update) [Internet]. Fontana: Global Initiative for Asthma; c2022 [cited 2023 Apr 14]. Available from: https://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf

DoH guidelines for the initial diagnosis and management of asthma in adults (≥18yrs) by primary healthcare providers [Internet]. Department of Health; [cited 2023 Apr 14]. Available from: https://www.doh.gov.ae/-/media/0899673803614D4385646B26A4B25BA0.ashx

Dubai standards of care 2018 - ISAHD [Internet]. ISAHD; [cited 2023 Apr 14]. Available from: https://www.isahd.ae/content/docs/Asthma%20Guidelines.pdf

British guideline on the management of asthma [Internet]. British Thoratic Society; [cited 2023 Apr 14]. Available from: https://www.brit-thoracic.org.uk/document-library/guidelines/asthma/btssign-guideline-for-the-management-of-asthma-2019/

Al Huneiti R, Saeed B, Nusr R, Radwan E, Al-Katheeri H. National clinical guidelines: the diagnosis and management of asthma in adults. Qatar Med J. 2022;2022:12. [DOI] [PubMed] [PMC]

Al-Moamary MS, Alhaider SA, Alangari AA, Idrees MM, Zeitouni MO, Al Ghobain MO, et al. The Saudi Initiative for Asthma - 2021 update: guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med. 2021;16:4–56. [DOI] [PubMed] [PMC]

Larenas-Linnemann D, Salas-Hernández J, Del Río-Navarro BE, Luna-Pech JA, Navarrete-Rodríguez EM, Gochicoa L, et al. MIA 2021, comprehensive asthma management. Guidelines for Mexico. Rev Alerg Mex. 2021;68:s1–122. Spanish. [DOI] [PubMed]

Nakamura Y, Tamaoki J, Nagase H, Yamaguchi M, Horiguchi T, Hozawa S, et al.; Japanese Society of Allergology. Japanese guidelines for adult asthma 2020. Allergol Int. 2020;69:519–48. [DOI] [PubMed]

Plaza V, Alobid I, Alvarez C, Blanco M, Ferreira J, García G, et al. Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. highlights and controversies. Arch Bronconeumol. 2022;58:150–8. Spanish. [DOI] [PubMed]

10.

Yang CL, Hicks EA, Mitchell P, Reisman J, Podgers D, Hayward KM, et al. Canadian Thoracic Society 2021 Guideline update: diagnosis and management of asthma in preschoolers, children and adults. Can J Respir Crit Care Sleep Med. 2021;5:348–61. Erratum in: Can J Respir Crit Care Sleep Med. 2022;6:141. [DOI]

11.

Baldacci S, Simoni M, Maio S, Angino A, Martini F, Sarno G, et al.; ARGA Collaborative Group. Prescriptive adherence to GINA guidelines and asthma control: an Italian cross sectional study in general practice. Respir Med. 2019;146:10–7. [DOI] [PubMed]

12.

Song P, Adeloye D, Salim H, Dos Santos JP, Campbell H, Sheikh A, et al. Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study. J Glob Health. 2022;12:04052. [DOI] [PubMed] [PMC]

13.

Al Busaidi N, Alweqayyan A, Al Zaabi A, Mahboub B, Al-Huraish F, Hameed M, et al. Gulf asthma diagnosis and management in adults: expert review and recommendations. Open Respir Med J. 2022;16:e187430642205230. [DOI] [PubMed] [PMC]

14.

Alomary SA, Al Madani AJ, Althagafi WA, Adam IF, Elsherif OE, Al-Abdullaah AA, et al. Prevalence of asthma symptoms and associated risk factors among adults in Saudi Arabia: a national survey from Global Asthma Network phase I. World Allergy Organ J. 2022;15:100623. [DOI] [PubMed] [PMC]

15.

Al-Jahdali H, Wali S, Salem G, Al-Hameed F, Almotair A, Zeitouni M, et al. Asthma control and predictive factors among adults in Saudi Arabia: results from the epidemiological study on the management of asthma in asthmatic Middle East adult population study. Ann Thorac Med. 2019;14:148–54. [DOI] [PubMed] [PMC]

16.

GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019. Lancet. 2020;396:1204–22. Erratum in: Lancet. 2020;396:1562. [DOI] [PubMed] [PMC]

17.

Ziyab AH, Abul AT. Trends in asthma hospital admissions and mortality in Kuwait, 2000–2014: a national retrospective observational study. BMJ Open. 2018;8:e021244. [DOI] [PubMed] [PMC]

18.

de Marco R, Cazzoletti L, Cerveri I, Corsico A, Bugiani M, Accordini S, et al.; ISAYA Study Group. Are the asthma guideline goals achieved in daily practice? A population-based study on treatment adequacy and the control of asthma. Int Arch Allergy Immunol. 2005;138:225–34. [DOI] [PubMed]

19.

Boskabady MH, Rezaeitalab F, Rahimi N, Dehnavi D. Improvement in symptoms and pulmonary function of asthmatic patients due to their treatment according to the Global Strategy for Asthma Management (GINA). BMC Pulm Med. 2008;8:26. [DOI] [PubMed] [PMC]

20.

Why asthma still kills [Internet]. London: Royal College of Physicians; [cited 2023 Apr 14]. Available from: http://www.rcplondon.ac.uk/sites/default/files/why-asthma-still-kills-full-report.pdf

21.

Asthma pocket guide for health care professionals [Internet]. Ministry of Health; [cited 2020 May 5]. Available from: https://www.moh.gov.sa/en/Ministry/About/Health%20Policies/Asthma-Pocket-Guide-for-Health-Care-Professionals.pdf

22.

Boulet LP, Reddel HK, Bateman E, Pedersen S, FitzGerald JM, O’Byrne PM. The Global Initiative for Asthma (GINA): 25 years later. Eur Respir J. 2019;54:1900598. [DOI] [PubMed]

23.

Crompton G. A brief history of inhaled asthma therapy over the last fifty years. Prim Care Respir J. 2006;15:326–31. [DOI] [PubMed] [PMC]

24.

Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343:332–6. [DOI] [PubMed]

25.

Hancox RJ, Cowan JO, Flannery EM, Herbison GP, McLachlan CR, Taylor DR. Bronchodilator tolerance and rebound bronchoconstriction during regular inhaled β-agonist treatment. Respir Med. 2000;94:767–71. [DOI] [PubMed]

26.

Bateman ED, Reddel HK, O’Byrne PM, Barnes PJ, Zhong N, Keen C, et al. As-needed budesonide–formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378:1877–87. [DOI] [PubMed]

27.

Lin J, Zhou X, Wang C, Liu C, Cai S, Huang M. Symbicort^® Maintenance and Reliever Therapy (SMART) and the evolution of asthma management within the GINA guidelines. Expert Rev Respir Med. 2018;12:191–202. [DOI] [PubMed]

28.

O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zheng J, Gustafson P, et al. Effect of a single day of increased as-needed budesonide–formoterol use on short-term risk of severe exacerbations in patients with mild asthma: a post-hoc analysis of the SYGMA 1 study. Lancet Respir Med. 2021;9:149–58. [DOI] [PubMed]

29.

O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, et al. Inhaled combined budesonide–formoterol as needed in mild asthma. N Engl J Med. 2018;378:1865–76. [DOI] [PubMed]

30.

Wang G, Zhang X, Zhang HP, Wang L, Kang Y, Barnes PJ, et al. Corticosteroid plus β₂-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis. Respir Res. 2017;18:203. [DOI] [PubMed] [PMC]

31.

Barnes PJ. Scientific rationale for inhaled combination therapy with long-acting β₂-agonists and corticosteroids. Eur Respir J. 2002;19:182–91. [DOI] [PubMed]

32.

Global strategy for asthma management and prevention, 2021 [Internet]. Fontana: Global Initiative for Asthma; [cited 2023 Apr 14]. Available from: https://ginasthma.org/wp-content/uploads/2022/05/GINA-2021-Main-Report_FINAL_V2_tracked-WMS.pdf

33.

Reddel HK, FitzGerald JM, Bateman ED, Bacharier LB, Becker A, Brusselle G, et al. GINA 2019: a fundamental change in asthma management. Eur Respir J. 2019;53:1901046. [DOI] [PubMed]

34.

Ish P, Malhotra N, Gupta N. GINA 2020: what’s new and why? J Asthma. 2021;58:1273–7. [DOI] [PubMed]

35.

Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global Initiative for Asthma strategy 2021: executive summary and rationale for key changes. Am J Respir Crit Care Med. 2022;205:17–35. [DOI] [PubMed] [PMC]

36.

Levy ML, Bacharier LB, Bateman E, Boulet LP, Brightling C, Buhl R, et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med. 2023;33:7. [DOI] [PubMed] [PMC]

37.

Zeitouni MO, Al-Moamary MS, Coussa ML, Riachy M, Mahboub B, AlHuraish F, et al. Challenges and recommendations for the management of asthma in the Middle East and Africa. Ann Thorac Med. 2022;17:71–80. [DOI] [PubMed] [PMC]

38.

Yousef HA, Koura M, Yousef AA. Knowledge about bronchial asthma management in primary health care physicians in Al-Khobar city, Saudi Arabia. J Family Community Med. 2015;22:1–7. [DOI] [PubMed] [PMC]

39.

Abuzakouk M, Jacob S, Ghorab O. Are the Global Initiative for Asthma (GINA) guidelines being correctly used to diagnose severe asthma in the UAE? Cureus. 2020;12:e12278. [DOI] [PubMed] [PMC]

40.

Nguyen VN, Nguyen QN, Le An P, Chavannes NH. Implementation of GINA guidelines in asthma management by primary care physicians in Vietnam. Int J Gen Med. 2017;10:347–55. [DOI] [PubMed] [PMC]

41.

Chapman KR, An L, Bosnic-Anticevich S, Campomanes CM, Espinosa J, Jain P, et al. Asthma patients’ and physicians’ perspectives on the burden and management of asthma. Respir Med. 2021;186:106524. [DOI] [PubMed]

42.

Chapman KR, Canonica GW, Lavoie KL, Nenasheva N, Garcia G, Bosnic-Anticevich S, et al. Patients’ and physicians’ perspectives on the burden and management of asthma: results from the APPaRENT 2 study. Respir Med. 2022;201:106948. [DOI] [PubMed]