Have You Checked for Updates Lately?
A Major Change in GINA Reports for Asthma Management
The healthcare world is filled with stepwise procedures and therapy regimens. Have an ear infection? You will have to make an appointment with your doctor. Then call out of work, or maybe change your schedule. Take time to travel to the office and then the pharmacy…all before you can get your hands on some antibiotics. For those of you who are healthcare workers, the prior authorization wheel of having to try “this” before “that” is covered, will have caused you to pay closer attention to what needs to be prescribed and dispensed first. Or even more simply, instinctively asking for name and date of birth before fully interacting with a patient. Regardless of the point of view, we all adhere to a generalized flow. However, always sticking to habitual actions can be very detrimental to those who consider themselves clinicians.
The Status Quo of Medicine is Constantly Evolving
As a 4th year pharmacy student and future medication expert, I have been fortunate enough to be shown the importance of staying up to date on guidelines and medications.
I came across this update during a PPCP SOAP note exercise, in which my staged patient had uncontrolled asthma. I utilized the GINA guidelines rather than my class notes to formulate my assessment and recomendation. I was shocked to find that a low-dose ICS + formoterol (i.e. Symbicort) was preferred over a SABA (i.e. albuterol). During the debrief of the exercise, my professor explains what the proper course of action should be for our patient. To her dismay, some students stuck to the familiarity of their notes or an older downloaded version of the reference, and were unaware of this new development.
“Inhaled SABA has been first-line treatment for asthma for 50 years”
Turns out she purposely chose asthma as the excercise topic to inform us of the change, and physically show us the impact of relying on notes. This change suddenly became a talking point at work. I had to pull up the proof because like myself, they had become accustomed to albuterol being the gold standard as a reliver in asthma mangement. The reaction to this update is not an over exaggeration. It is an appropriate response since up until recently, inhaled SABA was an unquestionable first-line treatment for 50 years.
Months later, a preceptor requests a presentational overview on this same disease state. My classmate chose to utilize the most recent GINA report and was met with skepticism when summarizing the figure below. Her preceptor was unaware of this latest development.
There are still clinicians who are unaware. My purpose for choosing to write on this topic is to:
- Provide readers with a brief PharmacyOS: GINA2020 update (Apple© users, see what I did there?)
2. Remind my community of healthcare professionals that guidelines and stepwise procedures can and will change as new significant research is conducted.
These changes may happen 1 year or 10 years from now. I simply urge you to be open and vigilant of new developments as they arise. This will ensure that YOUR patients will receive the best clinical care.
What Has Changed?
Several things! The most notable being that a low-dose ICS + formoterol inhaler is the preferred controller and reliever in the management of asthma over a SABA. Short-acting beta agonists have now been demoted to an alternative reliever. ICS + formoterol has been shown to decrease exacerbations and therefore the rate of hospitalizations in asthma patients.
GINA also contains evidence-based strategies that may be implemented in asthma patients during the COVID-19 pandemic, such as:
Avoiding nebulizers where possible
Avoiding spirometry in patients with confirmed/suspected COVID-19
For a more comprehensive list of updates on this topic please visit: https://ginasthma.org/gina-reports/
Which Resource/Guideline Should I Utilize?
Depends! At this time the choice can vary as institutions, practitioners, etc will favor one over the other.
However, please take note that GINA was recently updated this year and is revised annually. Also, as its name denotes, the GINA (Global Initiative for Asthma) report offers globalized recommendations when treating asthma patients. While the Guidelines for the Diagnosis and Management of Asthma (EPR-3) was last updated in 2012 and is presented by the National Institute of Health’s National Heart Lung and Blood Institute here in the United States.
How Can I Stay Up To Date?
Avoid the use of old notes or previously downloaded versions! I recommend going to the APhA website. Here you can find guidelines categorized by system and disease state.
Another option is to access these guidelines directly from the organization who publishes it. You may also subscribe to FDA or Medscape for alerts*.
*Please note: there is a risk of those emails going unseen if you receive a ton of emails throughout the day.
