Lately there has been an animated discussion on the adjustments GINA 2020 made to asthma pharmacotherapy and further changes that were made recently in GINA 2021: bottomline: we should try to avoid at all cost SABA only use.
Two treatment tracks are proposed, Track 1 and Track 2, the former being the preferred one. In 12+yo patients with asthma GINA 2021 suggests to fuse Step 1 and 2, leaving for both groups only rescue ICS-FORM, without maintenance as preferred therapy (Track 1), with rescue SABA + ICS as alternative Step 1 and ICS maintenance and SABA rescue as alternative Step 2.
Patients with symptoms once a month or less and no risk-factors for exacerbations would be candidates to start in Step 1.
DISCUSSION QUESTION: should we get rid of Step 1 all together, and only leave it as a possible step-down from Step 2 once patients are fully controlled?
Dear Désirée Larenas-Linnemann
These links might be useful to find out, have a look:
1. https://www.who.int/ncds/management/Protocol3_1_Asthma.pdf
2. https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-treatment/art-20044284
3. https://link.springer.com/article/10.1186/s13223-020-00472-8
Kind Regards
Qamar Ul Islam
I would strongly recommend that post pond step one only for stepping down step 2.
use of low dose ICS + formoterol as needed in Step 1 for adults or adolescents is an Evidence B recommendation : supported by indirect evidence of reduction of risk of exacerbation compared with SABA only treatment.
Article Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma