We have become aware that the GINA 2019 recommendation for ‘Preferred reliever’ in Steps 3-5 is sometimes being misinterpreted. Please note the following important information.
In the GINA 2019 treatment ﬁgure for adults and adolescents (Box 3-5A), Steps 3-5 show the medication options for patients with moderate to severe asthma in whom modiﬁable causes of symptoms or exacerbations have been addressed.!In these patients, low-dose ICS-formoterol is the preferred reliever only for patients who are prescribed maintenance and reliever therapy with ICS-formoterol. GINA does not recommend use of ICS-formoterol as the reliever for patients taking combination ICS-LABA medications with a different LABA. For these patients,
their as-needed reliever inhaler should be a short-acting b2-agonist (SABA).
To help clarify this issue, an extra slide (#12) has been added to the ‘What’s new in GINA 2019?’ slide set on the GINA website. The slide set can be downloaded from https://ginasthma.org/gina-reports/.
The maintenance and reliever regimen (sometimes called ‘MART’ or ‘SMART’) is approved in many countries for use with low dose beclometasone-formoterol or low dose budesonide-formoterol. With this regimen, the patient receives ICS-formoterol as their regular twice-daily or once-daily maintenance treatment, and takes additional doses of a low-dose ICS-formoterol for relief of symptoms, instead of as-needed short-acting b2-agonist.
About the maintenance and reliever regimen (GINA 2019, page 52): “In adult and adolescent patients with ≥1 exacerbation in the previous year, the ICS-formoterol maintenance and reliever regimen signiﬁcantly reduces exacerbations and provides similar levels of asthma control at relatively low doses of ICS, compared with a ﬁxed dose of ICS-LABA as maintenance treatment or a higher dose of ICS, both with as-needed SABA [GINA 2019 references 202-207] (Evidence A). Low dose ICS-formoterol is the preferred reliever for patients prescribed the maintenance and reliever treatment regimen. It should not be used as the reliever for patients taking combination ICS-LABA medications with a different LABA.”