Diagnosis and Management of Asthma – The Swiss Guidelines

Abstract

The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA (“Global Strategy for Asthma Management and Prevention”) report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a “new” definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient.

Postinfectious bronchiolitis obliterans masked by misdiagnosis as asthma

“…9 On the other hand, patients with either asthma or PIBO could respond to inhaled β2agonist or steroid treatment or both, which is another source of confusion in the diagnosis. 2,12 In our study, there was no difference between the two groups in terms of steroid and inhaled β2-agonist use.…”

“…PIBO is clinically characterized by severe and persistent airway obstruction despite the use of bronchodilators such as inhaled β2‐ agonists and systemic/inhaled steroids 9 . On the other hand, patients with either asthma or PIBO could respond to inhaled β2‐agonist or steroid treatment or both, which is another source of confusion in the diagnosis 2,12 . In our study, there was no difference between the two groups in terms of steroid and inhaled β2‐agonist use.…”

“…The observed frequency of asthma ranges from 1% to 18% across countries around the world 1 . It is usually related to airway inflammation and airway hyperresponsiveness to various stimuli 2 . The diagnosis of asthma is difficult, especially for children under the age of 5.…”

The Effects of Corticosteroids on the Respiratory Microbiome: A Systematic Review

“…In COPD, inhaled steroids are an important component of the available armamentarium and signi cantly slow the decline in quality of life and lower the exacerbation rate (34). Inhaled CS treatment is likewise a pillar of asthma therapy recommended by national and international guidelines (35,36). The role of the respiratory microbiome in mediating these effects is only being uncovered gradually.…”

Can montelukast correct immune dysregulation in preschool children with mild persistent asthma?

“…28,29 Asthma severity is determined according to the Global initiative of Asthma (GINA). 30 Twenty children matched for age and sex, with no history of allergic or respiratory disease, were chosen as the control group. Children were excluded if they have received a long-term controller therapy or systemic corticosteroids, or had concomitant infections, or any chronic inflammatory disorders.…”