Assessing the Effect of 2019 GINA Classification Changes in Patients With Asthma

Researchers sought to characterize the effect of the changes in the GINA 2019 recommendations in a real-world patient setting.

This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.

The 2019 Global Initiative for Asthma (GINA) recommendations included changes that can potentially affect clinical practice. These changes allocated a higher proportion of patients to GINA Step 5; therefore, clinicians should be aware of these updates to better understand the effect of inhaled corticosteroid (ICS) treatment to the level of disease severity, according to study results presented at the CHEST Annual Meeting 2020, held virtually October 18 to 21.

In a retrospective analysis conducted by Fernando Holguin et al, the effect of the 2019 changes to the GINA recommendations was evaluated using data acquired from Symphony Health from October 2013 to 2018. Patients aged 18 years and older, who had 2 or more claims indicating an asthma diagnosis on separate dates, had 2 years of active enrollment prior to the index date, and could be classified according to GINA 2018 and GINA 2019 criteria were included in the analysis.

A total of approximately 4.2 million patients were identified, and nearly 2 million met the criteria for this analysis. When patients were classified according to GINA 2018 criteria, 28%, 13%, 12%, 31%, and 5% were assigned to GINA Steps 1, 2, 3, 4, and 5, respectively. Following application of GINA 2019 criteria, 28%, 13%, 12%, 17%, and 19% were classified as GINA Steps 1, 2, 3, 4, and 5, respectively. Patients classified as GINA Step 5 — those requiring high-dose ICS combined with a long-acting beta agonist (LABA) — accounted for 6% and 23% of primary care providers’ asthma patient populations in 2018 and 2019, respectively. Similarly, among allergists and pulmonologists, the proportion of patients classified as GINA Step 5 increased by 19% for both specialists from 2018 to 2019.

“Overall, two-thirds of patients retained the same GINA Step classification across the 2018 and 2019 classifications, white one-third moved to a different step when applying GINA 2019,” concluded the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Holguin F, Camargo C, Busse W, et al. Impact of changes in the 2019 GINA treatment classification: assessment in a real-world setting. Presented at: the CHEST Virtual Annual Meeting 2020; October 18-21, 2020. Abstract 1.