How to Live More Easily with Asthma: Key Takeaways from the Global GINA Guidelines

 This article summarizes the most important practical questions and answers for people living with asthma, based on the leading scientific publication “Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update,” published in 2023 in npj Primary Care Respiratory Medicine (doi: 10.1038/s41533-023-00330-1). This publication was created by an international team of leading physicians and researchers in the field of respiratory diseases, including Dr. Mark L. Levy (UK), Prof. Leonard B. Bacharier (USA), Prof. Eric Bateman (South Africa), Prof. Louis-Philippe Boulet (Canada), Prof. Chris Brightling (UK), and other experts from universities and hospitals in Europe, North and South America, Asia, and Australia.

The article presents a concise summary of current Global Initiative for Asthma (GINA) recommendations for the diagnosis, treatment, and long-term management of asthma patients—with a special focus on practical, easy-to-understand guidance that can help patients and their families make more informed health decisions.

“Asthma treatment is not a ‘one-size-fits-all’ approach—each decision should be personalized, with regular review and adaptation to the patient’s needs.”

Why Expert Opinions on Modern Asthma Treatment Matter

Asthma affects hundreds of millions of people worldwide and is the most common chronic disease in childhood. Over 365,000 people die from asthma every year—most of these deaths are preventable. For patients and their families, navigating the sea of medical information and outdated practices can be overwhelming, which is why the most recent, evidence-based guidelines are essential.

In 2022, the Global Initiative for Asthma (GINA) introduced an updated strategy that sets the standard for asthma diagnosis, treatment, and long-term control—with a particular focus on personalization and prevention of severe attacks. In the following expert quotes and commentary, you'll find essential recommendations that promote a modern, informed approach to managing asthma.

1. Why Is It Important to Confirm Asthma with Objective Tests?

“It is critical to confirm the diagnosis of asthma... Over- and under-diagnosis of asthma are common and are usually due to the lack of objective lung function testing which can demonstrate variable expiratory airflow limitation that will support the diagnosis of asthma and help to exclude other causes.”

Explanation: Patients should not rely solely on subjective symptoms like coughing, shortness of breath, or wheezing. Whenever possible, they should insist on objective testing such as spirometry or peak flow measurements to confirm the diagnosis and rule out other lung diseases.

2. What’s the Modern Standard for Asthma Treatment: Why Is SABA-Only Monotherapy No Longer Recommended?

“GINA no longer recommends treatment of asthma with SABA alone (without ICS) in adults, adolescents and children >5 years... because of the risk of severe asthma flare-ups (severe exacerbations) requiring emergency department presentation or hospitalization, and asthma-related death.”

Explanation: Short-acting bronchodilators (e.g., albuterol) provide quick relief but do not treat the underlying airway inflammation that drives asthma. Current recommendations include an inhaled corticosteroid (ICS) as an essential part of therapy—even for “mild” asthma.

3. Why Are Personalized Approaches and Regular Monitoring Critical for Long-Term Success?

“Asthma treatment is not ‘one size fits all’; GINA recommends individualized assessment, adjustment, and review of treatment... patients need regular review, assessment and adjustment. This involves assessment of asthma control, individual risk factors and comorbidities, with review and optimization of treatment, including careful attention to adherence and inhaler technique, and provision of individualized self-management education...”

Explanation: Every patient should have a personalized plan, undergo regular follow-ups, and be evaluated not just for symptoms but for risk factors such as flare-ups. Education is key—patients should know how to use their inhaler correctly, recognize early signs of worsening, and when to seek medical help.

4. When Should You Be Referred to a Specialist?

“For patients with moderate–severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS–formoterol. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care.”

Explanation: Patients who cannot achieve control despite medium or high-dose therapy and proper inhaler technique should be referred to a pulmonologist or allergist. Specialists have access to advanced therapies, including biologics, which are not typically available in primary care.

5. What Is the Importance of a Written, Personalized Asthma Action Plan?

“Give patients documented instructions about how to change their medications when their asthma worsens, and when to seek medical advice. Verbal instructions are often forgotten.”

Explanation and Practical Tips: Asthma is a chronic condition that can flare up suddenly. In stressful situations, like an asthma attack, it’s easy to forget what the doctor said. That’s why modern best practices include providing a written, clear, and easily accessible “asthma action plan.”

A good plan should include:

• What medications to take at different levels of symptoms—e.g., how to adjust treatment during mild, moderate, or severe symptoms.

• Warning signs that symptoms are getting worse—like increased need for a rescue inhaler, waking at night, trouble speaking or walking, or a low peak flow reading.

• When to seek immediate medical help—if symptoms don’t improve with usual treatment or a severe attack is occurring.

• Contact information for your healthcare provider or emergency services—including phone numbers and addresses.

Example from Practice: In Australia, the UK, and other countries, ready-to-use templates for asthma action plans are given to patients upon hospital discharge or even at the first diagnosis. Studies show that patients with written plans have fewer severe attacks, are hospitalized less often, and have better overall control.

Advice to Patients and Families: Don’t hesitate to ask your healthcare provider for a written asthma action plan! Review it regularly, keep it in an easy-to-find place (like your fridge or wallet), and share it with anyone who helps care for you or your child. If there are changes in your treatment or new symptoms arise, the plan should be updated.

Questions and Answers

1. How Can I Be Sure My Diagnosis Is Really Asthma and Not Another Respiratory Disease? Answer: Confirming asthma requires more than describing symptoms like coughing, shortness of breath, or wheezing. Objective tests such as spirometry or peak expiratory flow (PEF) measurements are essential. The diagnosis is supported if there is “variable airway obstruction”—for example, if lung function improves significantly (FEV1 increase of over 12% and 200 ml in adults) after using a bronchodilator. If test results are normal, they may be repeated during symptom flare-ups or followed by other provocation tests. The diagnosis and test results should be documented in your medical record.

2. If I’m a Child or Have a Young Child Who Wheezes, Is That Automatically Asthma? What Do Doctors Look For in Kids Under 5? Answer: Diagnosing asthma in children under 5 is challenging because wheezing is common with viral infections. Doctors look for symptom patterns—such as wheezing or coughing during running, laughing, playing with pets, or crying, not just when sick. Family history of asthma, eczema, or food allergies also matters, as well as response to inhaled corticosteroids. If symptoms return after stopping treatment, that’s another clue. Parents may be asked to record wheezing episodes (even using a phone), as verbal descriptions can be unclear.

3. What Other Health Conditions Can Worsen Asthma, and Should I Be Watching for Them? Answer: Several co-existing conditions can make asthma harder to control or treat, including obesity, chronic sinusitis, obstructive sleep apnea, gastroesophageal reflux (GERD), and mental health issues like anxiety or depression. GINA recommends these be addressed during routine asthma check-ups, as managing them can lead to better asthma control and fewer flare-ups. Tell your doctor about all symptoms, even if they don’t seem directly related to asthma.

4. What Are the Signs That My Asthma Isn’t Well Controlled and I Need to Seek Help? Answer: Asthma is considered poorly controlled if:

• You have daytime symptoms more than twice a week

• You wake up at night due to asthma

• Your physical activity is limited

• You use a rescue inhaler (SABA) more than twice a week (except for exercise)

• You’ve had ER visits, hospitalizations, or needed oral steroids in the past year

These are all red flags. You may need to see your doctor for a medication adjustment or referral to a specialist. Don’t wait for a severe attack.

5. Can I Reduce or Stop My Medications If I Feel Fine? What’s the Process? Answer: GINA recommends “step-down therapy” if your asthma has been well controlled for at least 2–3 months—but only under medical supervision. Before reducing medications, your doctor will assess:

• Day and night symptoms

• Frequency of rescue inhaler use

• Lung function test results (if available)

• Risk factors for severe flare-ups (e.g., past attacks, other health conditions)

How it’s done: Reduction is gradual—for example, lowering the dose of your inhaled corticosteroid or switching to a milder combination. Never stop medications abruptly. Your doctor will monitor for any new symptoms or drops in lung function. If problems arise, the previous effective dose will be reinstated. If you stay symptom-free on the lowest maintenance dose, treatment may eventually be stopped—but you’ll need close monitoring for at least 12 months, as the risk of relapse remains.

IMPORTANT: Never reduce or stop asthma medications on your own, even if you feel fine! Every change should be discussed and monitored by your healthcare provider. The goal is to use the lowest effective dose while maintaining good control and minimizing side effects.

Conclusion 

Modern asthma management requires not only access to quality treatment but also to clear, up-to-date, evidence-based information. The insights presented here—based on “Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update” and the international experience of leading specialists—highlight the importance of objective diagnosis, personalized therapy, and regular condition monitoring. The questions and answers included in this article are meant to support every asthma patient and their family in achieving better control, fewer flare-ups, and a calmer, healthier life.

Source: Levy, M. L., Bacharier, L. B., Bateman, E., Boulet, L.-P., Brightling, C., Buhl, R., Brusselle, G., Cruz, A. A., Drazen, J. M., Duijts, L., Fleming, L., Inoue, H., Ko, F. W. S., Krishnan, J. A., Mortimer, K., Pitrez, P. M., Sheikh, A., Yorgancıoğlu, A., Reddel, H. K. (2023). Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. npj Primary Care Respiratory Medicine, 33:7. https://doi.org/10.1038/s41533-023-00330-1