GINA strategy in the diagnosis, treatment and prevention of bronchial asthma

For those who have experienced asthma attacks, it is helpful to know about GINA. This is the short name for a group of specialists who, since 1993, have been working on the diagnosis and treatment of this disease.

Its full name is Global Initiative for Asthma (“Global Initiative on bronchial asthma”).

GINA explains what to do to the doctor, patient and his family with bronchial asthma, and already in the new millennium introduced the Day of the fight against bronchial asthma on December 11 , which reminds the whole world of this problem.

What is the GINA Asthma Program

Medical science is constantly evolving. Research is being conducted to shape a new perspective on the causes of disease.

From time to time GINA publishes the document “Global strategy for the treatment and prevention of bronchial asthma”, for which the group members select the most relevant and reliable materials on how bronchial asthma is diagnosed and treated.

They strive to make scientific advances available to medical professionals and ordinary people in all countries.

GINA definition of asthma

According to GINA, bronchial asthma is a multi-type disease in which chronic inflammation develops in the airways.

Infection does not always cause inflammation. And this is exactly the case when a wide range of allergens and irritants can become its culprit.

The bronchi with this disease become overly sensitive. In response to irritation, they spasm, swell and become clogged with mucus. The lumen of the bronchi becomes very narrow, breathing problems arise, including suffocation, which can be fatal.

GINA classification of bronchial asthma

This disease manifests itself in different ways in different people. Symptoms depend on age, lifestyle and individual characteristics of the body.

For example, allergies play a separate role in the development of the disease. For some reason, the immune defense system reacts to something that does not threaten the body.

But the allergic component is not detected in all patients. In women, bronchial asthma is not quite the same as in men.

The many-sided nature of bronchial asthma prompted GINA specialists to classify its variants.

GINA classification of bronchial asthma:

  1. Allergic bronchial asthma manifests itself already in childhood. Usually, boys start to get sick earlier than girls. Since allergies are associated with genetic characteristics, the species may differ in the child and his blood relatives. For example, atopic dermatitis, eczema, allergic rhinitis, food allergies, medications.
  2. In non-allergic bronchial asthma, no association with allergies is detected.
  3. In women of mature age (in men this happens less often), bronchial asthma occurs with a late onset. With this option, allergies are usually absent.
  4. After several years of illness, bronchial asthma with a fixed impairment of bronchial patency may develop . With prolonged inflammation, irreversible changes develop in them.
  5. Bronchial asthma against the background of obesity.

The recommendations pay special attention to children. It also specifically refers to pregnant women, the elderly and obese patients, and those who smoke or quit smoking. A special group is made up of athletes and people whose bronchial asthma is associated with professional activities. The onset of illness in adulthood may indicate exposure to hazardous substances at work. Here a serious question already arises about changing the place of work or profession.

Reasons for the development of bronchial asthma and provoking factors

The mechanism of development of bronchial asthma is too complex to be triggered by only one factor. And while the researchers still have many questions.

According to the GINA concept, genetic predisposition and the influence of the external environment play the main role in the occurrence of bronchial asthma.

Allergies, obesity, pregnancy, and respiratory diseases can trigger or exacerbate the disease.

The factors that provoke the appearance of symptoms of bronchial asthma have been identified:

  • physical exercise;
  • allergens of different nature. These can be dust mites, cockroaches, animals, plants, molds, etc.
  • respiratory tract irritation by tobacco smoke, polluted or cold air, strong odors, industrial dust;
  • weather and climatic factors;
  • acute respiratory disease (cold, flu);
  • strong emotional excitement.

During pregnancy, bronchial asthma also proceeds in different ways. In one third of cases, relief occurs, in another third, the condition worsens, in other cases no changes occur.

But under all circumstances, treatment is necessary to reduce the risks to the health of the mother and baby.

A 2018 GINA document highlights the link between asthma and the menstrual cycle. It has been noticed that in 20% of women, the symptoms of the disease intensify before menstruation.

As a rule, these are women of mature age who are overweight and have problems with the menstrual cycle. Their exacerbation lasts longer, is more severe, and is more likely to develop asthma symptoms when taking aspirin.

Verification of the diagnosis

When diagnosing, the doctor asks and examines the patient, and then prescribes an examination.

GINA has identified the characteristic symptoms of bronchial asthma. These are whistles and wheezing, a feeling of heaviness in the chest, shortness of breath, choking, coughing.

As a rule, there is not one, but several symptoms at once (two or more). They become stronger at night or immediately after sleep, provoked by the above factors.

They can go away on their own or with medication, and sometimes do not appear for weeks. A history of these symptoms and spirometry data help distinguish bronchial asthma from similar diseases.

With bronchial asthma, exhalation becomes difficult and slows down. It is his strength and speed that spirometry evaluates.

After inhaling as deeply as possible, the doctor asks the patient to exhale sharply and forcefully, thus assessing the forced vital capacity (FVC) and the forced expiratory volume (FEV1).

If the disease is not started, the bronchi often narrow and widen. This is influenced by a huge number of factors, for example, the period of the course of the disease or the season of the year.

Therefore, FEV1 may differ with each new survey. This is not surprising, as this is very typical for asthma.

Moreover, in order to assess the variability of this indicator, a test is carried out with a bronchodilator – a drug that expands the bronchi.

There is also a peak expiratory flow rate (PEF) indicator, although it is less reliable. You can only compare the results of studies carried out using the same device, since the readings for different devices can be very different.

The advantage of this method is that with the help of a peak flow meter, a person can independently assess the degree of narrowing of their bronchi.

Therefore, the signs most characteristic of bronchial asthma are a decrease in the FEV1 / FVC ratio (less than 0.75 in adults and less than 0.90 in children) and variability in FEV1.

Other tests may be done with spirometry: exercise test and bronchoconstriction test.

With young children, the situation is more complicated. Viral infections in them also cause wheezing and coughing.

If these symptoms do not occur by chance, but are associated with laughing, crying or physical activity, if they also occur when the child is sleeping, this suggests bronchial asthma.

It is also more difficult for a child to undergo spirometry, so for children GINA provides for additional tests.

GINA Asthma Treatment

Unfortunately, it is impossible to finally cope with this disease. GINA recommendations for the treatment of bronchial asthma are aimed at prolonging life and improving its quality.

For this, the patient needs to strive to take control of the course of bronchial asthma. The doctor not only prescribes medications, but also helps to adjust the lifestyle. He develops a plan of action for the patient in different situations.

As a result of successful treatment, a person returns to his favorite work or sport, women can give birth to a healthy child. Olympic champions, political leaders, media personalities lead an active rich life with this diagnosis.

GINA offers three types of drugs for the medical treatment of bronchial asthma:

  • inhaled non-hormonal agents relieve asthma attacks and prevent choking caused by exercise or other causes. They quickly expand the bronchi and allow breathing to be restored;
  • inhaled glucocorticosteroids – hormones that suppress inflammation. With this method of application, they are safer and do not cause serious complications;
  • additional medications for severe disease.

Drug therapy consists of several stages. The more severe the disease is, the higher the level, the more drugs are prescribed and the higher their doses.

With a mild course, drugs are used only to eliminate an attack of suffocation; at subsequent steps, drugs from other groups are added to them.

Most medicines come in aerosols. The doctor explains and shows how to use the medication devices correctly. It happens that they give a weak effect precisely because of errors in their application.

Without which treatment will not be effective

But the fight against the disease is not limited to medicines alone. A person needs to organize his life himself so as to reduce the manifestations of the disease. The following measures will help in this:

  • quitting smoking, avoiding the society of smokers;
  • regular physical activity;
  • elimination of allergens and polluted air at work and at home;
  • caution when taking medications that can aggravate the course of bronchial asthma. Some people may have intolerance to pain relievers such as aspirin (non-steroidal anti-inflammatory drugs, or NSAIDs). The decision to take beta-blockers is made by the doctor, taking into account the situation and the individual characteristics of the patient;
  • breathing exercises;
  • a healthy diet, a large amount of vegetables and fruits in the diet;
  • body weight correction;
  • influenza vaccination in case of severe to moderate asthma;
  • bronchial thermoplastics. With a long course of the disease, the muscles of the bronchi are hypertrophied. Bronchial thermoplasty removes part of the muscle layer, the lumen of the bronchi increases. This procedure allows you to reduce the frequency and dosage of inhaled glucocorticoids. It is held in several countries: USA, Germany, Israel;
  • training in emotional state management;
  • allergen-specific immunotherapy. In allergen-specific immunotherapy, the patient is administered micro doses of the allergen, gradually increasing the dosage. Such treatment should reduce sensitivity to this allergen in daily life. Treatment is not suitable for everyone and should be done with caution.

It is important to assess symptom control. When a patient comes for a scheduled examination, the doctor invites him to answer questions about the state of his health over the past 4 weeks:

  1. Did you experience bronchial asthma symptoms more than twice a week during the day?
  2. Are the manifestations of the disease disturbed at night.
  3. Are medications used to relieve seizures more than twice a week (this does not include pre-exercise emergency medications).
  4. Whether asthma limits normal activity.

The questions can be phrased in a slightly different way, but the main thing is to assess how the disease affects a person’s daily life.

GINA recommendations for the prevention of bronchial asthma

It is believed that there is a period of time during a woman’s pregnancy and the first months of a child’s life, when environmental factors are able to trigger the mechanism for the development of the disease.

To reduce the risks, GINA offers the following actions for the prevention of bronchial asthma:

  • the expectant mother urgently needs to quit smoking during pregnancy, and preferably before her, and refrain from cigarettes after childbirth;
  • if possible, do not resort to caesarean section;
  • breastfeeding is preferred;
  • do not use broad-spectrum antibiotics in the first year of a child’s life unless absolutely necessary.

As for the impact of allergens, not everything is clear. Dust mite allergens definitely cause allergies. Research on pet allergens is conflicting.

In Russia, it is recommended not to have pets, aquarium fish and birds if the family has an allergy sufferer.

It is important to maintain a good psychological environment in the family. This always helps to cope with any disease.

Summing up, we can say that the prevention of the development and exacerbation of asthma comes down to the following points:

  • quit smoking as soon as possible and do not allow others to smoke. Tobacco smoke not only maintains chronic inflammation in the airways, but, most dangerous, provokes asthma attacks. It can cause another disease, chronic obstructive pulmonary disease (COPD). The combination of both pathologies worsens the condition, and also complicates the diagnosis and selection of treatment;
  • exclude contact with allergens as much as possible;
  • avoid smoke, exhaust gases, cold air, strong odors;
  • get a flu shot in the absence of contraindications, try not to catch a cold;
  • choose the right medicine. Taking painkillers (NSAIDs) and beta-blockers is possible only in consultation with your doctor
  • regular practice of permitted sports, taking into account the doctor’s recommendations (you may need to take preventive medications to prevent an attack of suffocation);


Bronchial asthma makes it difficult to fully experience the taste of life. It is dangerous because the complete absence of symptoms is suddenly replaced by an attack of suffocation, sometimes fatal.

In different countries, it is detected in 1 – 18% of the population, often starting in childhood.

GINA specialists understand that their recommendations in different countries are accepted taking into account the specifics of local health care.

This article provides only general information about the views of this international organization on bronchial asthma. Only a doctor can correctly recognize and prescribe treatment for each patient.

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