International Survey on GINA Strategy: ICS/Formoterol in Asthma Management

2 Jun, 21

Introduction

The Global Initiative for Asthma (GINA) critically revises the evidence on asthma management annually and provides a structured set of recommendations. The 2020 GINA report included a major change in the recommendations, wherein treatment with short-acting beta-2 agonists (SABA) alone was no longer recommended due to safety issues. The current GINA Report recommends the use of the combination of inhaled corticosteroids (ICS) with the rapid/long-acting beta-2 agonist formoterol, instead of SABA alone, including in steps 1 and 2, where the use is still off-label in the EU and in many countries. It is important to understand clinicians’ knowledge and opinions on the asthma management with an objective to encourage the implementation of the new approach in clinical practice.

Aim

An international survey was conducted across pulmonologists to understand their perspective in the management of patients with asthma and to garner their outlook on the changes introduced in the GINA report from 2019.

Method

Study Design

International survey based on a questionnaire of 42 open and closed questions.

Participant Selection and Method

Pulmonologists from different countries were enrolled, having more than 5 years of clinical experience in respiratory disease, wherein patients with asthma represented at least 25% of their practice in the last month, and at least 80% of their patients were adults (≥18 years).
The questionnaire was delivered online
The questions were open and closed with multiple choice.

Results

A total of 160 pulmonologists answered the questionnaire – 10 from Netherlands and 30 each from Italy, Germany, Brazil, China and Russia.
53% had more than 15 years of clinical experience.
Asthma patients represented about 47% of patients’ visits each month.
The most likely prescribed therapy for patients in GINA step 1 was as-needed low-dose ICS/formoterol for 44% of clinicians.
As-needed low-dose ICS/formoterol was prescribed to about 37% of patients.
As-needed low-dose ICS/formoterol was the most likely prescribed reliever therapy in any step for 61% of clinicians and prescribed to 52% of the patients
The clinicians’ prescription choice was based on the following references as shown in Figure 1.

Figure 1. Points of reference in prescription choice

Overall, 83% of pulmonologists were aware of updates in the 2019 GINA Report.
34% of participants perceived introduction of ICS/formoterol as the major change introduced in 2019, while the recommendation not to use SABA in monotherapy was the key change for 30% of clinicians.
Overall, 91% of pulmonologists were willing to follow the new recommendations.

Conclusions

Most pulmonologists are up to date and appreciate the changes in GINA reports from 2019 and are willing to include them in their clinical practice.
Nevertheless, dissemination and implementation of GINA novel management strategy is still warranted.

Asthma Res Pract. 7, 1 (2021). Doi: 10.1186/s40733-021-00067-z.