Study Reveals Gaps in GINA Guideline Adherence for Asthma Treatment

A retrospective study presented at the American Society of Health-System Pharmacists 2025 Pharmacy Futures meeting has revealed significant variability in asthma treatment regimens following initial diagnosis, with many patients not receiving care aligned with the Global Initiative for Asthma (GINA) recommendations.¹

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The GINA guidelines, widely recognized for establishing best practices in asthma management, have moved away from recommending short-acting β agonist (SABA) monotherapy due to safety concerns. Instead, GINA endorses 2 primary treatment tracks²:

• Track 1 (preferred) involves an inhaled corticosteroid (ICS)-formoterol used either as needed for symptom relief or as part of maintenance and reliever therapy (MART).
• Track 2 (alternative) involves daily ICS-containing maintenance therapy, typically with a long-acting β agonist (LABA), plus SABA for as-needed relief.

Despite this shift, the study found that many prescribing practices did not fully align with these recommendations.

Study Overview

Researchers conducted a retrospective chart review of 80 patients aged 12 or older within Intermountain Health who were diagnosed with asthma between December 2022 and December 2023. To ensure continuity of care, patients included had seen a primary care provider both in the year prior to and following their diagnosis. Pulmonary function tests and provider documentation were manually reviewed to confirm asthma diagnoses, while individuals with other pulmonary diseases were excluded.¹

The study’s primary goal was to analyze prescribed asthma regimens within 12 months of diagnosis, assessing their alignment with GINA track 1, track 2, or non-GINA-supported treatment plans. Secondary outcomes included rates of specialist referrals and asthma-related emergency department (ED) visits or hospitalizations.¹

Key Findings

The study found that SABA remained the most commonly prescribed asthma medication, used by 76% of patients, despite GINA’s clear guidance against its use as monotherapy. ICS therapy was prescribed to 75% of patients. Of those, 19% received ICS without a LABA, while 56% received combination ICS/LABA therapy. Only 20% of patients were prescribed regimens that aligned with GINA’s preferred track 1 treatment, which includes the use of ICS-formoterol either as MART or as needed for symptom relief. Within this group, 69% used ICS-formoterol as MART, and 31% used it on an as-needed basis.¹

In contrast, 55% of patients were treated with track 2 regimens, consisting of daily ICS-containing maintenance therapy alongside as-needed SABA. Among those in track 2, 66% were on ICS/LABA combinations, while 34% received ICS alone. Notably, 25% of patients were prescribed regimens that did not align with GINA recommendations. These included SABA monotherapy in 80% of cases, SABA with leukotriene receptor antagonists (LTRA) in 15%, and LTRA monotherapy in 5%.¹

The study also observed that 65% of patients had a documented visit with an asthma specialist during the follow-up period. Asthma exacerbations requiring acute care were rare but notable: 1 patient visited the ED, and 3 were hospitalized, all of whom were in the track 2 group.¹

Implications for Practice

The data underscore a critical gap between clinical guidelines and real-world prescribing practices. Despite growing evidence supporting the safety and effectiveness of track 1 therapy—including reduced risk of exacerbations and overreliance on SABAs—it remains underutilized. The overprescription of SABA, especially as monotherapy, continues to pose a concern. According to GINA, frequent SABA use is associated with an increased risk of severe asthma attacks and mortality.²

The observed asthma exacerbations in patients treated under track 2 highlight the importance of reevaluating initial treatment strategies, particularly as ICS-formoterol MART regimens have been shown to reduce exacerbation risk significantly in clinical trials.³

Moving Forward

As pharmacists continue to play a pivotal role in asthma management through medication education, adherence support, and collaborative care, there is a clear opportunity to enhance guideline implementation. The study authors emphasize that improving adherence to GINA guidelines—especially increasing utilization of track 1 therapies—could lead to better patient outcomes and fewer severe exacerbations.¹

For health systems, this research provides a compelling case for auditing prescribing practices and developing targeted interventions, such as pharmacist-led asthma management programs, to bring practice in line with evidence-based recommendations.

REFERENCES

1. Alasaibei Y, Crockett K, Hays E, Higley L. A comprehensive evaluation of asthma therapy within a large healthcare system. Presented at: American Society of Health-System Pharmacists 2025 Pharmacy Futures. Charlotte, NC; June 9, 2025.

2. 2024 Global Strategy for Asthma Mnagement and Prevention Guidelines. Global Initiative for Asthma. Accessed June 9, 2025. https://ginasthma.org/2024-report/

3. Beasley R, Holliday M, Reddell HK, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380:2020-2030. doi:10.1056/NEJMoa1901963