The Global Initiative for Asthma (GINA) released an update to their Global Strategy for Asthma Management and Prevention guidelines. This update is the result of a routine, twice-yearly review of the literature by the GINA Science Committee and extensive debate regarding the latest research.
With fifteen key updates highlighted below, we’re providing a brief rundown of each to help you understand what’s new in the 2025 update. Refer to the full text version of the guideline update for the most thorough explanation of these and other recommendations.
Key Elements of the 2025 Update:
- Biomarkers of Type 2 Inflammation
Clinicians should carefully consider patient eligibility for Type 2-targeted biologic therapy based on factors contributing to variations in fractional exhaled nitric oxide and blood eosinophil count. - Risk Factors for Severe Exacerbations in Adults and Adolescents
With the publication of the ORACLE2 study, GINA reiterates the fact that environmental factors, external factors, and factors like Type 2 biomarkers remain in consideration for patients’ risk level of future exacerbations. - Impact of Extreme Weather
Climate change and extreme weather factors have indirect and direct effects on increasing the overall risk level of asthma-related exacerbations. - Diagnosis of Asthma in Children Aged 5 Years and Younger
Asthma can be diagnosed in children in this age range based on observing recurring wheezing, lack of other alternative diagnosis, asthma treatment yielding positive outcomes. - Treatment of Asthma in Children Aged 5 Years or Younger
Updates to the original guidelines reflect changes in personalized asthma management and asthma medication options for patients in this age range. - Asthma Exacerbations in Children Aged 5 Years and Younger
Changes to the original guidelines reflect updates on the use of magnesium sulfate and dosage levels of inhaled medications for patients within this age range. - Diagnosis of Asthma in Adults and Adolescents
The diagnostic flowchart for this age group was updated to emphasize the limited role of biomarkers in diagnosing asthma. - Diagnostic Criteria for Asthma
The phrase, “variable expiratory airflow,” replaced the phrase, “variable expiratory airflow limitation,” for clarity. For additional emphasis, the role of biomarkers in diagnosing asthma was better highlighted along with a calculator for peak expiratory flow variability. - Personalized Asthma Care: Assess-Adjust-Review
The cycle of care graphic was reworked for the first time since 2014. Providing clarity on reviewing response to treatment guidance was the focus of the adjustment. - Population-level and Personalized Patient-level Treatment Decisions
This section’s update emphasized the important considerations around population-level and patient-level (comorbidities, patient views, phenotypic characteristics, and practical issues) treatment decisions by implementing the information into an easier-to-process figure, rather than a table. - Treatment Recommendations for Adults and Adolescents
Box 4-2 was updated to reflect new dose reclassifications of fluticasone furoate; low-medium (100 mcg) and medium-high (200 mcg). Track 1 in box 4-6 is the preferred track of the two presented due to being a simpler regime that notably reduces health risks. In Track 2, the recommendation of a medium-to-high dose of ICS-LABA was reduced to being a “medium-dose” recommendation. The list of non-recommended bronchodilators now includes fenoterol. - Shared Decision-making for Inhaler Choice
The order of consideration factors was adjusted for clarity and for patient accessibility. - Action Plans
The previous table in box 9-2 was reorganized for clarity within the respective treatment tracks. - Treatment of Severe Exacerbations in Adults, Adolescents, and Children 6–11 Years Old
Nebulized magnesium was removed from the recommendations. Dose clarifications were made to avoid excess use. - Severe Asthma Decision Tree
The tree was updated to be simpler to understand in regards to identifying asthma in patients.
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