27 Questions
What is the preferred controller in Track 1 of asthma management according to GINA guidelines?
Low-dose ICS with formoterol
How does the reliever in Track 1 differ from the controller in terms of usage?
The reliever is also used for symptom relief as needed
Which track is preferred overall due to its impact on reducing severe exacerbations in asthma management?
Track 1: Low-Dose ICS–Formoterol
What is the primary reason for using low-dose ICS-formoterol as the reliever in asthma management?
To reduce the need for oral corticosteroids
What characteristic makes Track 2 an alternative approach to asthma management?
Inability to use Track 1
Why does GINA recommend individualized treatment plans in asthma management?
To reduce the risk of severe exacerbations
Which non-pharmacologic strategy is recommended to improve symptom control and reduce the risk of exacerbations?
Receiving smoking cessation advice
What is the initial step healthcare providers should take before considering a regimen with SABA reliever in asthma management according to GINA guidelines?
Assess if the patient is unlikely to adhere to daily controller treatment
What distinguishes Track 2 from Track 1 in asthma management according to GINA guidelines?
The type of medication used as the reliever
In which scenario should healthcare providers consider a regimen with SABA reliever in asthma management?
After confirming that the patient is unlikely to adhere to daily controller treatment
Why does GINA emphasize patient adherence to daily controller treatment before considering SABA reliever?
To ensure optimal symptom control and prevent exacerbations
What makes Track 2 an alternative approach in asthma management according to GINA guidelines?
Using an alternative controller and reliever strategy
Which medication is a combination of budesonide and formoterol?
Symbicort
Which medication is NOT a controller for asthma according to the provided text?
Albuterol (Proair HFA)
Which medication is recommended specifically for reducing severe exacerbations in asthma management?
Fluticasone-vilanterol (Breo)
Which medication combination is considered an alternative approach in asthma management according to GINA guidelines?
Mometasone-formoterol (Dulera)
What is a potential systemic side effect associated with high doses or prolonged use of inhaled corticosteroids?
Adrenal suppression
Which inhaled corticosteroid showed dose-related cortisol suppression comparable to oral prednisolone in the text?
Fluticasone propionate
Why is it essential to monitor the use of inhaled corticosteroids according to the text?
To minimize systemic side effects
What is the purpose of adjusting dosages when using inhaled corticosteroids as mentioned in the text?
To maximize benefits while reducing systemic side effects
Which area of the body can be affected by prolonged use of inhaled corticosteroids due to systemic side effects?
Endocrine system
What is the primary benefit of inhaled corticosteroids in asthma management?
Preventing asthma exacerbations
Which potential side effect is associated with the long-term use of inhaled corticosteroids in asthma treatment?
Adrenal suppression
What distinguishes fluticasone propionate from other inhaled corticosteroids like beclomethasone dipropionate or budesonide?
Greater anti-inflammatory effects
Why may the use of higher doses of fluticasone propionate not significantly improve the therapeutic index in severe asthma?
Higher doses result in greater cortisol suppression without much improvement in efficacy
In severe asthma cases, what indicates that a balance must be maintained when using inhaled corticosteroids?
Risk of greater cortisol suppression compared to symptom improvement
Which effect is NOT associated with the use of inhaled corticosteroids in asthma treatment?
Preventing adrenal suppression
Study Notes
GINA Guidelines: Preferred Controller and Reliever for Asthma Management
The Global Initiative for Asthma (GINA) provides an evidence-based framework for the prevention and management of asthma. The guidelines emphasize the importance of individualized treatment plans, taking into account patient characteristics, preferences, and the healthcare system's considerations. In the context of asthma management, GINA provides two primary tracks, each with different controller and reliever options.
Track 1: Low-Dose ICS–Formoterol
Track 1 is preferred overall because it reduces the risk of severe exacerbations compared with using a short-acting beta-agonist (SABA) reliever, with similar symptom control, similar lung function, and lower oral corticosteroid (OCS) burden. In this track:
- Controller: The preferred controller is low-dose inhaled corticosteroids (ICS) with formoterol, which is used as needed for symptom relief and provides the patient's controller therapy in steps 1–2.
- Reliever: The reliever is also low-dose ICS–formoterol, which is used as needed for symptom relief and reduces the risk of severe exacerbations without daily maintenance treatment.
Track 2: SABA (Short-Acting Beta-2 Agonists)
Track 2 is an alternative approach, especially if Track 1 is not possible or not preferred by a patient with no exacerbations in the last year. In this track:
- Controller: The controller is a low-dose ICS, which may be taken whenever a SABA is taken for symptom relief.
- Reliever: The reliever is a SABA, which is used as needed for symptom relief and is not recommended as the preferred controller or reliever due to its increased risk of severe exacerbations.
GINA Guidelines for Children
The GINA guidelines for children aged 6–11 also provide stepped treatment options:
- Step 1: For children with initial symptoms less than twice per month, taking ICS whenever SABA is taken for symptom relief is preferred over regular ICS or as-needed SABA alone.
- Step 2: Regular, low-dose ICS with as-needed SABA is recommended for most children with asthma, but attention must be paid to adherence.
- Step 3: Options include low-dose ICS–LABA, medium-dose ICS, or very-low-dose budesonide–formoterol MART (maintenance-and-reliever therapy).
Choice of Controller and Reliever
The choice of controller and reliever depends on the patient's individual risk factors, comorbidities, and treatment goals. Non-pharmacologic strategies, such as smoking cessation advice and trigger avoidance, may also be used to improve symptom control and reduce the risk of exacerbations.
For exercise-induced symptoms, ICS-containing controller treatment and advice on sufficient warm-up before exercise are recommended. Patients using as-needed ICS–formoterol as their reliever can use the same medication before exercise and do not need a SABA inhaler.
For children, the guidelines recommend regular training in inhaler technique and asthma self-management, including self-monitoring of symptoms and/or PEF (peak expiratory flow), and a written asthma action plan.
Conclusion
The GINA guidelines provide a comprehensive framework for asthma management, focusing on individualized treatment plans and risk reduction. The choice of controller and reliever depends on the patient's individual needs, preferences, and risk factors, with Track 1 being the preferred approach overall due to its reduced risk of severe exacerbations.
Learn about the Global Initiative for Asthma (GINA) guidelines on choosing the preferred controller and reliever options for asthma management. Understand the differences between Track 1 (Low-Dose ICS–Formoterol) and Track 2 (SABA) approaches, as well as the stepped treatment options for children. Explore the importance of individualized treatment plans and non-pharmacologic strategies.
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