A worldwide charter for all children with asthma

2008

Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled ''A Global Strategy for Asthma Management and Prevention'', first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that ''it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,'' and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

European Respiratory Journal, 2008

Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled ''A Global Strategy for Asthma Management and Prevention'', first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that ''it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,'' and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

The Lancet Global Health

Background Asthma is one of the most common non-communicable diseases globally. This study aimed to assess asthma medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood across different country settings. Methods We used data from the Global Asthma Network Phase I cross-sectional epidemiological study (2015-20). A validated, written questionnaire was distributed via schools to three age groups (children, 6-7 years; adolescents, 13-14 years; and adults, ≥19 years). Eligible adults were the parents or guardians of children and adolescents included in the surveys. In individuals with asthma diagnosed by a doctor, we collated responses on past-year asthma medicines use (type of inhaled or oral medicine, and frequency of use). Questions on asthma symptoms and health visits were used to define past-year symptom severity and extent of asthma control. Income categories for countries based on gross national income per capita followed the 2020 World Bank classification. Proportions (and 95% CI clustered by centre) were used to describe results. Generalised structural equation multilevel models were used to assess factors associated with receiving medicines and having poorly controlled asthma in each age group. Findings Overall, 453 473 individuals from 63 centres in 25 countries were included, comprising 101 777 children (6445 [6•3%] with asthma diagnosed by a doctor), 157 784 adolescents (12 532 [7•9%]), and 193 912 adults (6677 [3•4%]). Use of asthma medicines varied by symptom severity and country income category. The most used medicines in the previous year were inhaled short-acting β2 agonists (SABA; range across age groups, 29•3-85•3% participants) and inhaled corticosteroids (12•6-51•9%). The proportion of individuals with severe asthma symptoms not taking inhaled corticosteroids (inhaled corticosteroids alone or with long-acting β2 agonists) was high in all age groups (934 [44•8%] of 2085 children, 2011 [60•1%] of 3345 adolescents, and 1142 [55•5%] of 2058 adults), and was significantly higher in middle-to-low-income countries. Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines. Asthma management plans were used by 4049 (62•8%) children, 6694 (53•4%) adolescents, and 3168 (47•4%) adults; and 2840 (44•1%) children, 6942 (55•4%) adolescents, and 4081 (61•1%) adults had well controlled asthma. Independently of country income and asthma severity, having an asthma management plan was significantly associated with the use of any type of inhaled medicine (adjusted odds ratio [OR] 2•75 [95% CI 2•40-3•15] for children; 2•45 [2•25-2•67] for adolescents; and 2•75 [2•38-3•16] for adults) or any type of oral medicine (1•86 [1•63-2•12] for children; 1•53 [1•40-1•68] for adolescents; and 1•78 [1•55-2•04] for adults). Poor asthma control was associated with low country income (lower-middle-income and low-income countries vs high-income countries, adjusted OR 2•33 [95% CI 1•32-4•14] for children; 3•46 [1•83-6•54] for adolescents; and 4•86 [2•55-9•26] for adults). Interpretation Asthma management and control is frequently inadequate, particularly in low-resource settings. Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries.

Allergy, 2012

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices; however, this goal has not yet been achieved.

Social Science Research Network, 2022

Background Asthma is one of the most common non-communicable diseases globally. This study aimed to assess asthma medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood across different country settings. Methods We used data from the Global Asthma Network Phase I cross-sectional epidemiological study (2015-20). A validated, written questionnaire was distributed via schools to three age groups (children, 6-7 years; adolescents, 13-14 years; and adults, ≥19 years). Eligible adults were the parents or guardians of children and adolescents included in the surveys. In individuals with asthma diagnosed by a doctor, we collated responses on past-year asthma medicines use (type of inhaled or oral medicine, and frequency of use). Questions on asthma symptoms and health visits were used to define past-year symptom severity and extent of asthma control. Income categories for countries based on gross national income per capita followed the 2020 World Bank classification. Proportions (and 95% CI clustered by centre) were used to describe results. Generalised structural equation multilevel models were used to assess factors associated with receiving medicines and having poorly controlled asthma in each age group. Findings Overall, 453 473 individuals from 63 centres in 25 countries were included, comprising 101 777 children (6445 [6•3%] with asthma diagnosed by a doctor), 157 784 adolescents (12 532 [7•9%]), and 193 912 adults (6677 [3•4%]). Use of asthma medicines varied by symptom severity and country income category. The most used medicines in the previous year were inhaled short-acting β2 agonists (SABA; range across age groups, 29•3-85•3% participants) and inhaled corticosteroids (12•6-51•9%). The proportion of individuals with severe asthma symptoms not taking inhaled corticosteroids (inhaled corticosteroids alone or with long-acting β2 agonists) was high in all age groups (934 [44•8%] of 2085 children, 2011 [60•1%] of 3345 adolescents, and 1142 [55•5%] of 2058 adults), and was significantly higher in middle-to-low-income countries. Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines. Asthma management plans were used by 4049 (62•8%) children, 6694 (53•4%) adolescents, and 3168 (47•4%) adults; and 2840 (44•1%) children, 6942 (55•4%) adolescents, and 4081 (61•1%) adults had well controlled asthma. Independently of country income and asthma severity, having an asthma management plan was significantly associated with the use of any type of inhaled medicine (adjusted odds ratio [OR] 2•75 [95% CI 2•40-3•15] for children; 2•45 [2•25-2•67] for adolescents; and 2•75 [2•38-3•16] for adults) or any type of oral medicine (1•86 [1•63-2•12] for children; 1•53 [1•40-1•68] for adolescents; and 1•78 [1•55-2•04] for adults). Poor asthma control was associated with low country income (lower-middle-income and low-income countries vs high-income countries, adjusted OR 2•33 [95% CI 1•32-4•14] for children; 3•46 [1•83-6•54] for adolescents; and 4•86 [2•55-9•26] for adults). Interpretation Asthma management and control is frequently inadequate, particularly in low-resource settings. Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries.

Paediatric Respiratory Reviews, 2002

European Respiratory Journal, 2012

In 1995, the Global Initiative for Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical practice and research, its major objective, of forming the basis for local and national initiatives to improve services for asthma patients, remains to be achieved. Over recent years, the science of guideline implementation has progressed, and encouraging examples of successful asthma programmes have been published. This report is intended to draw on this experience and assist with the translation of asthma guideline recommendations into quality programmes for patients with asthma using current knowledge translation principles. It also provides examples of successful initiatives in various socioeconomic settings.

 A summary of the new GINA strategy: a roadmap to asthma control  Reddel HK et al. Eur Respir J 2015; 46: 622-39 (free full text)  Summarizes key changes in GINA 2014-15, with their rationale  We recommend that this article should be read as a companion piece to the GINA report itself  The GINA asthma strategy report: what's new for primary care?  Reddel HK, Levy ML. NPJ Prim Care Respir Med 2015; 25: 15050 (free full text)  Summary of key changes in the GINA report for primary care  GINA 2014: a global asthma strategy for a global problem  Reddel HK et al. Int J Tuberc Lung Dis 2014; 18: 505-6 (free full text)  Emphasizing the distinction between population-level and individualized patient-level decisions  The revised 2014 GINA strategy report: opportunities for change  Boulet LP et al. Curr Opin Pulm Med 2015; 21: 1-7  Describes the context that prompted key changes in the GINA report Peer-reviewed articles about GINA GINA 2017