The Global Initiative for Asthma (GINA) recently released a 2026 update to its guideline, The Global Strategy for Asthma Management and Prevention (GINA Strategy Report). The annual report, published regularly since 2002, provides guidance to specialists, primary care practitioners, and other health professionals on reducing asthma prevalence, morbidity, and mortality. 

The annual guideline update is the result of literature searches conducted twice a year, each covering the previous 18 months of randomized clinical trials and observational studies. The following highlights reflect some of the latest major updates to the GINA Strategy Report for 2026. View the full-text version of the 2026 GINA Strategy Report a complete look at all the updates featured in this year’s guideline.

Management of Acute Asthma in Primary Care and in Acute Care Facilities
  • Four new flowcharts were added regarding assessment, treatment, and follow-up of four designated patient demographics: Adults, adolescents, and children ages 6 through 11 presenting in primary care or to an acute care facility or emergency department; Children 5 years and younger presenting in primary care or to an acute care facility or emergency department. 
  • A recommendation was added to each flowchart that if a patient presents with features of anaphylaxis and asthma, first give epinephrine and then bronchodilators. 
  • Oxygen saturation thresholds and targets were revised down. Supplemental oxygen is not recommended unless saturation falls under 92%. For adults, adolescents, and children between 6 and 11 years old, the upper limit of oxygen saturation target is 95%. For children 5 years and younger who have severe asthma exacerbation or acute wheezing, the target saturation is ≥92%.
  • For the treatment of adults, adolescents, and children between the ages of 6 and 11 years old, presenting in primary care or the emergency department with mild exacerbation, ICS-formoterol has been added as an alternate option to inhaled SABA.
  • A suggestion was added regarding shaking salbutamol (albuterol) inhalers before each actuation to avoid accidentally administrating ultra-high doses.
  • A lung function measurement using spirometry or peak flow is recommended for all patients, with some age-related exclusions, along with an additional measurement before discharge.
  • For patients experiencing even a single exacerbation requiring urgent health care or OCS treatment, their asthma treatment should be reviewed for preventive purposes. 
Diagnosis of Asthma in Adults, Adolescents, and Children 6-11 Years Old
  • The flowchart for the diagnosis of asthma was simplified.
  • Bronchodilator Responsiveness: A comment was added regarding previous criteria resulting in the underdiagnosis of asthma, notably in young males. 

Asthma Treatment in Children 6 to 11 Years Old

  • Anti-Inflammatory Reliever (AIR) Therapy with Budesonide-Formoterol in Step 1 and 2: It was noted that in children between 5 and 15 years old, low-dose budesonide-formoterol, used as-needed for relief, reduced the risk of moderate-severe exacerbations by nearly 50%, compared with SABA alone. Additional age-related directions and comments are provided.
  • Consensus advice regarding the step of treatment initiation regarding the initiation of asthma treatment in children 6 to 11 years old was added.
Asthma Treatment in Adults and Adolescents
  • GINA track 2: Anti-inflammatory reliever (AIR) therapy with combination ICS-SABA was added at step 1. 
  • Dose instructions for AIR and MART were simplified, focusing on the most commonly available formulations of ICS-formoterol. 
  • A note prompting a patient to seek medical care if they have needed to use more than a specified number of inhalations in a 24 hour period was added for safety. A similar prompt was added for SABA.
  • Evidence about add-on LAMAs in adults and adolescents in GINA step 5 was updated. It was noted that the reduction of severe exacerbations with triple combination therapy, compared to ICS-LABA, was far less than the reductions achieved with biologic therapy, but triple therapy may be useful in patients who don’t qualify for biologics. 
Severe Asthma
  • Two new biologics were added: depemokimab and generic anti-IgE. 
  • A table was added that lists examples of non-asthma indications for the current four classes of asthma biologic therapy.
  • Clearer guidance is now provided in the section of the severe asthma decision tree regarding biologic therapy. 
Inhaler Technique
  • Additional details were provided regarding the single-breath and tidal breathing techniques with pMDI and space. 
  • A note on shaking pMDIs was included that states: For all pMDIs formulated as a suspension, including salbutamol (albuterol(, budesonide-formoterol, and fluticasone propionate-salmeterol, it is essential to shake the inhaler immediately before each actuation. 
New Tools for Assessment of Patients with Asthma (CAAT, Peds-AIRQ, PRAM)
  • Information was added on the chronic airways assessment test (CAAT). The simple, eight-item tool provides a comprehensive patient-centered evaluation of health status across respiratory disease in adults, including questions about sputum and energy. 
  • The pediatric asthma impairment and risk questionnaire (Peds-AIRQ) is a composite score developed in children 5 through 11 years old. Higher scores are associated with higher risk of exacerbations, but children with reconized as “well-controlled asthma” with Peds-AIRQ can still experience exacerbations.
  • Pediatric Respiratory Assessment Measure (PRAM): For children under 18 years old who present with an exacerbation, there is now a strong recommendation to use a validated clinical score for assessment of its severity.
Other Updates
  • Regarding vaccinations, evidence was updated regarding the effectiveness of influenza, RSV, and COVID-19 vaccines. 
  • A brief update was added regarding observational data on a potential future role of glucagon-like peptide-1 receptor agonists in improving asthma outcomes.
  • Doses of inhaled medicine, where relevant, are not expressed as delivered doses, with metered doses in parentheses.

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