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The Impact of the Global Initiative for Asthma (GINA): Compass, Concepts, Controversies and Challenges

The Global Initiative for Asthma (GINA) was established in 1993 to provide a global asthma strategy, adaptable to the needs of different countries. Over the past five years, GINA has initiated substantial changes in key concepts about asthma and its management, and in the structure and content of the GINA strategy report. These changes have sometimes generated controversy, but they have been welcomed in primary care, where most asthma is managed. The changes discussed in this review include a new definition of asthma that emphasises its heterogeneity; expansion of the scope of evidence considered by GINA, to give priority to both internal and external validity of research findings; and the integration throughout the report of practical advice about tailoring of treatment across the whole spectrum of asthma severity. The GINA report provides not only evidence-based recommendations, but also multiple practical resources for implementation in clinical practice. (BRN Rev. 2019;5(1):4-18) Corresponding author: Helen K. Reddel, helen.reddel@sydney.edu.au