GINA asthma 2024 GUIDELINES

Summary

This video delves into the latest updates from the 2024 Global Initiative for Asthma (GINA) guidelines, highlighting key changes in asthma diagnosis, treatment, and management. It discusses the role of fractionated exhaled nitric oxide (FeNO) in assessing medication adherence and airway inflammation, the use of biologic therapies, and updates to spirometry criteria for asthma reversibility. The video also covers the psychological effects of asthma medications, particularly for younger patients, and emphasizes the benefits of pulmonary rehabilitation in improving asthma patients' quality of life and functional exercise capacity.

Takeaways

• 😀 Fractionated Exhaled Nitric Oxide (FeNO) levels are a key indicator of airway inflammation in asthma patients, and a decrease in FeNO after ICS therapy suggests reduced inflammation.
• 😀 The Fractionated Exhaled Nitric Oxide suppression test helps assess adherence to inhaled corticosteroids and is used to monitor asthma control.
• 😀 The 2024 Gen asthma guidelines emphasize the importance of assessing bronchodilator response to confirm the reversibility of airflow limitation.
• 😀 A reduction in FeNO levels after ICS treatment indicates a positive response and can help guide therapy adjustments.
• 😀 Cough Variant Asthma is characterized by cough as the main symptom, with normal spirometry, and it is diagnosed with a bronchial provocation test.
• 😀 The 2024 guidelines now define reversibility of airflow limitation as an improvement in FEV1 by more than 12% or by 200 mL after bronchodilator use.
• 😀 The 2024 guidelines raise the bronchodilator response threshold from a 10% to a 12% improvement or a 200 mL increase in FEV1 to confirm reversibility.
• 😀 It is important for healthcare providers to discuss potential neuropsychiatric side effects of asthma medications, especially for adolescents and young children.
• 😀 The guidelines stress the need for patient education on the side effects of medications, particularly for younger patients, due to increased awareness on social media.
• 😀 Pulmonary rehabilitation has been shown to improve functional exercise capacity and quality of life in asthma patients, as demonstrated in systematic reviews.

Q & A

What is the Fractionated Exhaled Nitric Oxide (FeNO) test, and how does it relate to asthma management?

The FeNO test measures the level of exhaled nitric oxide to assess airway inflammation in asthma patients. It is particularly used to monitor adherence to inhaled corticosteroid (ICS) therapy. A high FeNO level may indicate poor adherence to ICS, which increases the risk of asthma exacerbations. The test helps guide treatment by determining whether ICS therapy is effectively reducing inflammation.

How does the Fractionated Exhaled Nitric Oxide (FeNO) test help in assessing the effectiveness of ICS therapy?

The FeNO test is used to assess the effectiveness of ICS therapy by measuring nitric oxide levels before and after administering high-dose ICS. If the FeNO levels decrease significantly after the treatment, it indicates that the ICS therapy is successfully reducing airway inflammation in the patient.

What is cough variant asthma, and how is it diagnosed?

Cough variant asthma is a phenotype of asthma where coughing is the predominant symptom. Spirometry may appear normal, so it is diagnosed through bronchial provocation tests, which assess airway responsiveness. This type of asthma is typically treated with inhaled corticosteroids.

How is bronchial responsiveness measured in asthma, and what does it indicate?

Bronchial responsiveness is measured using spirometry, where a ratio of FEV1/FVC (forced expiratory volume/forced vital capacity) is calculated. If the ratio is less than 70%, it indicates airflow limitation. After administering a bronchodilator, an improvement in FEV1 of more than 12% or 200 mL suggests that the airflow limitation is reversible, which is a characteristic of asthma.

What change was made to the criterion for bronchial reversibility in the updated 2024 guidelines?

The 2024 guidelines have updated the bronchial reversibility criterion from an improvement of 12% in FEV1 to an improvement of more than 200 mL in FEV1 after the administration of a bronchodilator. This change helps to better assess the reversibility of airflow limitation in asthma patients.

What neuropsychiatric effects are associated with leukotriene receptor antagonists (LTRA), and why is this important for asthma treatment?

Leukotriene receptor antagonists (LTRA) have been associated with neuropsychiatric effects, such as mood changes, anxiety, and agitation. These effects have garnered attention, particularly on social media, and it is important for clinicians to advise patients, especially adolescents and children, about these potential side effects when prescribing LTRA for asthma treatment.

How does pulmonary rehabilitation benefit asthma patients?

Pulmonary rehabilitation has been shown to benefit asthma patients by improving functional exercise capacity and overall quality of life. It involves a comprehensive program of exercise, education, and support to help patients manage asthma more effectively and improve their physical fitness.

What role do biologic therapies play in asthma treatment, according to the updated guidelines?

Biologic therapies play a significant role in the treatment of moderate to severe asthma, especially in patients who do not respond well to standard treatments like ICS. These therapies are tailored to target specific pathways involved in asthma inflammation and can improve asthma control in patients with certain phenotypes.

How do the updated guidelines address the management of asthma in children aged 6 to 11 years?

The updated guidelines emphasize the importance of informing caregivers and parents of children aged 6 to 11 years about the potential neuropsychiatric effects of asthma medications, particularly leukotriene receptor antagonists (LTRA). This ensures that caregivers are aware of possible side effects and can make informed decisions about treatment.

What changes have been made to the management of moderate to severe asthma in the 2024 guidelines?

The 2024 guidelines emphasize personalized treatment for moderate to severe asthma, with a greater focus on biologic therapies for patients who have poor control with traditional treatments. Additionally, the guidelines update diagnostic criteria and emphasize monitoring tools like FeNO to assess treatment effectiveness and adherence.