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© Global Initiative for Asthma GINA Global Strategy for Asthma Management and Prevention Global Initiative for Asthma (GINA) What’s new in GINA 2015?
© Global Initiative for Asthma Add-on tiotropium by soft-mist inhaler is a new ‘other controller option’ for Steps 4 and 5, in patients ≥18 years with history of exacerbations Tiotropium was previously described in GINA as an add-on option on the basis of clinical trial evidence. It is now included in recommendations and the stepwise figure following approval for asthma by a major regulator. What’s new in GINA 2015 (1)
© Global Initiative for Asthma GINA 2015 – changes to Steps 4 and 5 © Global Initiative for Asthma GINA 2015, Box 3-5, Steps 4 and 5 *For children 6-11 years, theophylline is not recommended, and preferred Step 3 is medium dose ICS **For patients prescribed BDP/formoterol or BUD/formoterol maintenance and reliever therapy # Tiotropium by soft-mist inhaler is indicated as add-on treatment for patients with a history of exacerbations; it is not indicated in children <18 years. Other controller options RELIEVER STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 Low dose ICS Consider low dose ICS Leukotriene receptor antagonists (LTRA) Low dose theophylline* Med/high dose ICS Low dose ICS+LTRA (or + theoph*) As-needed short-acting beta 2 -agonist (SABA) Low dose ICS/LABA* Med/high ICS/LABA Refer for add-on treatment e.g. anti-IgE PREFERRED CONTROLLER CHOICE Add tiotropium# High dose ICS + LTRA (or + theoph*) Add tiotropium# Add low dose OCS As-needed SABA or low dose ICS/formoterol**
© Global Initiative for Asthma Management of asthma in pregnancy Monitor for respiratory infections and manage them appropriately, because of increased risk of exacerbations Management of asthma during labor and delivery Give usual controller, and SABA if needed, e.g. following hyperventilation Watch for neonatal hyperglycaemia (especially in preterm babies) if high doses of SABA used in previous 48 hours Breathing exercises Evidence level down-graded from A to B following review of quality of evidence and a new meta-analysis (Freitas, Cochrane 2013) The term ‘breathing exercises’ is used, rather than ‘breathing techniques’, to avoid any perception that a specific technique is recommended What’s new in GINA 2015 (2)
© Global Initiative for Asthma Mild or moderate exacerbations Dry powder inhalers as effective as puffer and spacer for delivery of SABA in worsening asthma or exacerbations (Selroos, Ther Deliv. 2014) Note that studies did not include patients with severe acute asthma Life-threatening or severe acute asthma in primary care While arranging transfer to acute care facility, give inhaled ipratropium bromide as well as SABA, systemic corticosteroids, and oxygen if necessary Pre-school children with acute exacerbations or wheezing episodes Clarification that parent-administered oral steroids or high dose ICS are not generally recommended for pre-school children with acute wheezing or exacerbations Respiratory infections and wheezing occur very frequently in this age-group There is substantial concern about the risk of systemic side-effects, especially with repeated use A new flow-chart for pre-school children is included in GINA 2015 What’s new in GINA 2015 (3)
© Global Initiative for Asthma GINA 2015, Box 6-8 Managing exacerbations or wheezing in pre-schoolers For more detail, see GINA 2015 slide kit
© Global Initiative for Asthma Assessment of risk factors: over-usage of SABA High usage of SABA is a risk factor for exacerbations (Patel et al, CEA 2013) Very high usage (e.g. >200 doses/month) is a risk factor for asthma-related death (Haselkom, JACI 2009) Beta-blockers and acute coronary events If cardioselective beta-blockers are indicated for acute coronary events, asthma is not an absolute contra-indication. These medications should only be used under close medical supervision by a specialist, with consideration of the risks for and against their use Asthma-COPD Overlap Syndrome (ACOS) The aims of the chapter are mainly to assist clinicians in primary care and non-pulmonary specialties in diagnosing asthma and COPD as well as ACOS, and to assist in choosing initial treatment for efficacy and safety A specific definition cannot be provided for ACOS at present, because of the limited populations in which it has been studied ACOS is not considered to represent a single disease; it is expected that further research will identify several different underlying mechanisms Other changes for clarification in GINA 2015 update
© Global Initiative for Asthma The work of GINA is now supported only by income generated from the sale of GINA products GINA resources are available at www.ginasthma.orgwww.ginasthma.org Other changes in GINA 2015
An Update in Pediatric Asthma DR.NUFOUD AL- SHAMMARI CONSULTANT PEDIATRIC PULMONOLOGIST CHAIRPERSON OF MUBARK AL-KABEER HOSPITAL KUWAIT.
Asthma Management Fine Tuning Maximum control with minimum medication Start with mild asthma and work up the scale (BTS/SIGN 2004)
1 British Guideline on the Management of Asthma BTS/SIGN British Guideline on the Management of Asthma, May 2008 Introduction Diagnosis Non-pharmacological.
© Global Initiative for Asthma Global Initiative for Asthma (GINA) Teaching slide set 2015 update This slide set is restricted for academic and educational.
Component 4 Medications. Key Points - Medications 2 general classes: – Long-term control medications – Quick-Relief medications Controller medications:
PICH Childhood Asthma project Bina Chauhan Locum GP 4/5/16.
Assessing Control & Adjusting Therapy in Youths > 12 Years of Age & Adults.
ASTHMA MANAGEMENT AND PREVENTION PREFACE Asthma affects an estimated 300 million individuals worldwide. Serious global health problem affecting all age.
GOLD MANAGEMENT PLAN FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
© Global Initiative for Asthma GINA Global Strategy for Asthma Management and Prevention 2015 This slide set is restricted for academic and educational.
AGGIORNAMENTO SULLA GESTIONE ATTUALE DELLA TERAPIA DELL’ASMA Pierluigi Paggiaro GINA International Executive Committee, Chairman GINA ITaly Cardio-Thoracic.
P RACTICAL ISSUES IN L ONG T REM M ANAGEMENT OF A STHMA DESPITE REGULAR FOLLOW UP Dr kondekar Santosh TN Medical college Mumbai
1 Component 4 Medications. 2 Key Points - Medications 2 general classes: – Long-term control medications – Quick-Relief medications Controller medications:
© Global Initiative for Asthma Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of.
DIFFICULT TO TREAT ASTHMA By PROF. RAMADAN M. NAFAE PROFESSOR AND HEAD OF CHEST DEPARTMENT FACULTY OF MEDICINE ZAGAZIG UNIVERSITY.
Drugs For Treating Asthma Chapter 9. Sympathomimetic Agents Noninfectious respiratory diseases are divided into two groups – Asthma is characterized by.
M.E.D.C Sezione di Pneumologia ed Allergologia, U.O. Pediatria 1 Azienda Ospedaliero-Universitaria Pisana, Pisa.
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Areas to cover Analysis of information Recruitment Review.
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Asthma Diagnosis Prescribing Acute Management Tracey Bradshaw Respiratory Consultant RIE.
Classification of Chronic Asthma Severity on Treatment Domains/EstimatesIntermittentPersistent Mild to Moderate Severe** Daytime symptoms MonthlyWeeklyDaily.
Managing asthma & Inhaler devices for respiratory disease.
Anticholinergics in COPD presented by: Soha Ragab Moselhy group 2.
GOLD Update 2011 Rabab A. El Wahsh, MD. Lecturer of Chest Diseases and Tuberculosis Minoufiya University REVISED 2011.
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Component 3: Pharmacologic Therapy n Asthma is a chronic inflammatory disorder of the airways. n A key principle of therapy is regulation of chronic airway.
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Exacerbations. Exacerbations An exacerbation of COPD is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond.
History Taking Zinc code: UKACL1878ea Date of preparation May 2015 AstraZeneca provided funding & reviewed for technical accuracy.
Inhaler technique is it important?. Compton et al (2006) Review of evidence from 6 European countries ( Spain, Italy, France, Germany, Netherlands, UK)
Wendy Pigg Practice support Pharmacist/Independent Prescriber.
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β2 Agonists Albuterol and other inhaled short-acting selective β2 agonists are indicated for treatment of intermittent episodes of bronchospasm and are.
Prescribing for patients with COPD Evidence Update Emma Blanden- Pharmacist.
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Childhood Asthma A triad of atopic eczema, allergic rhinitis and asthma is called atopy. The strongest risk factor for developing asthma is a history.
Responsible Respiratory Prescribing Dr Louise Restrick* and Dr Chris Cooper London Respiratory Team NHS Islington and Whittington Health*
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