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                 GLOBAL STRATEGY FOR
      ASTHMA MANAGEMENT AND PREVENTION
                            UPDATED 2010
                        © 2010 Global Initiative for Asthma
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                   Global Strategy for Asthma Management and Prevention 
                   The GINA reports are available on www.ginasthma.org. 
                                Global Strategy for Asthma Management and Prevention 2010 (update)
           GINA EXECUTIVE COMMITTEE*                                                         GINA EXECUTIVE COMMITTEE*
           Eric D. Bateman, MD, Chair                                                        Mark FitzGerald, MD, Chair 
           University Cape Town Lung Institute                                               University of British Columbia 
           Cape Town, South Africa                                                           Vancouver, BC, Canada 
           Louis-Philippe Boulet, MD                                                         Neil Barnes, MD 
           Hôpital Laval                                                                     London Chest Hospital 
           Sainte-Foy , Quebec, Canada                                                       London, England, UK 
           Alvaro A. Cru , MD                                                                Peter J. Barnes, MD 
           Federal University of Bahia                                                       National Heart and Lung Institute 
           School of Medicine                                                                London, England, UK 
           Salvador, Brazil 
                                                                                             Eric D. Bateman, MD 
           Mark FitzGerald, MD                                                               University Cape Town Lung Institute 
           University of British Columbia                                                    Cape Town, South Africa 
           Vancouver, BC, Canada 
                                                                                             Allan Becker, MD 
           Tari Haahtela, MD                                                                 University of Manitoba 
           Helsinki University Central Hospital                                              Winnipeg, Manitoba, Canada 
           Helsinki, Finland                                                                                          DISTRIBUTE
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                                                                                             Jeffrey M. Drazen, MD 
           Mark L. Levy, MD                                                                  Harvard Medical School 
           University of Edinburgh                                                           Boston, Massachusetts, USA 
           London England, UK                                                                          COPY 
                                                                                             Robert F. Lemanske, Jr., M.D. 
           Paul O’Byrne, MD                                                                  University of Wisconsin School of Medicine 
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           McMaster University                                                               Madison, Wisconsin, USA 
           Ontario, Canada                                                                DO 
                                                                                             Paul O’Byrne, MD 
           Ken Ohta, MD, PhD                                                                 McMaster University 
           Teikyo University School of Medicine                                              Ontario, Canada 
           Tokyo, Japan 
                                                                                             Ken Ohta, MD, PhD 
           Pierluigi Paggiaro, MD                                       MATERIAL-            Teikyo University School of Medicine 
           University of Pisa                                                                Tokyo, Japan 
           Pisa, Italy 
                                                                                             Soren Erik Pedersen, M.D. 
           Soren Erik Pedersen, M.D. Kolding Hospital                                        Kolding Hospital 
           Kolding, Denmark                                                                  Kolding, Denmark 
           Manuel Soto-Quiro, MD                                                             Emilio Pizichini, MD 
           Hospital Nacional de Niños            COPYRIGHTED                                 Universidade Federal de Santa Catarina 
           San José, Costa Rica                                                              Florianópolis, SC, Brazil 
           Gary W. Wong, MD                                                                  Helen K. Reddel, MD 
           Chinese University of Hong Kong                                                   Woolcock Institute of Medical Research 
           Hong Kong ROC                                                                     Camperdown, NSW, Australia 
                                                                                             Sean D. Sullivan, PhD 
                                                                                             Professor of Pharmacy, Public Health 
                                                                                             University of Washington 
                                                                                             Seattle, Washington, USA 
                                                                                             Sally E. Wenzel, M.D.
                                                                                             University of Pittsburgh 
                                                                                             Pittsburgh, Pennsylvania, USA 
           *Disclosures for members of GINA Executive and Science Committees can be found at: 
           http://www.ginasthma.com/Committees.asp?l1=7&l2=2
                                                                                                                                                                           i
                                                            PREFACE
         Asthma is a serious global health problem. People of all       In spite of these dissemination efforts, international 
         ages in countries throughout the world are affected by         surveys provide direct evidence for suboptimal asthma 
         this chronic airway disorder that, when uncontrolled, can      control in many countries, despite the availability of 
         place severe limits on daily life and is sometimes fatal.      effective therapies. It is clear that if recommendations 
         The prevalence of asthma is increasing in most countries,      contained within this report are to improve care of people 
         especially among children. Asthma is a significant burden,     with asthma, every effort must be made to encourage 
         not only in terms of health care costs but also of lost        health care leaders to assure availability of and access to 
         productivity and reduced participation in family life.         medications, and develop means to implement effective 
                                                                        asthma management programs including the use of 
         During the past two decades, we have witnessed many            appropriate tools to measure success. 
         scientific advances that have improved our understanding 
         of asthma and our ability to manage and control it             In 2002, the GINA Report stated that “It is reasonable 
         effectively. However, the diversity of national health         to expect that in most patients with asthma, control 
         care service systems and variations in the availability        of the disease can, and should be achieved and 
         of asthma therapies require that recommendations for           maintained.”  To meet this challenge, in 2005, Executive 
         asthma care be adapted to local conditions throughout          Committee recommended preparation of a new report 
         the global community. In addition, public health officials     not only to incorporate updated scientific information 
         require information about the costs of asthma care, how        but to implement an approach to asthma management 
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         to effectively manage this chronic disorder, and education     based on asthma control, rather than asthma severity. 
         methods to develop asthma care services and programs           Recommendations to assess, treat and maintain asthma 
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         responsive to the particular needs and circumstances           control are provided in this document. The methods used 
         within their countries.                                        to prepare this document are described in the Introduction. 
                                                                               COPY 
         In 1993, the National Heart, Lung, and Blood Institute         It is a privilege for me to acknowledge the work of the 
         collaborated with the World Health Organization to             many people who participated in this update project, as 
                                                                         NOT 
         convene a workshop that led to a Workshop Report:              well as to acknowledge the superlative work of all who 
                                                                     DO 
         Global Strategy for Asthma Management and Prevention.          have contributed to the success of the GINA program. 
         This presented a comprehensive plan to manage asthma 
         with the goal of reducing chronic disability and premature     The GINA program has been conducted through 
         deaths while allowing patients with asthma to lead             unrestricted educational grants from AstraZeneca, 
         productive and fulfilling lives.               MATERIAL-       Boehringer Ingelheim, Chiesi Group, GlaxoSmithKline, 
                                                                        Meda Pharma, Merck, Sharp & Dohme, Mitsubishi Tanabe 
         At the same time, the Global Initiative for Asthma (GINA)      Pharma, Novartis, Nycomed, PharmAxis and Schering-
         was implemented to develop a network of individuals,           Plough. The generous contributions of these companies 
         organizations, and public health officials to disseminate      assured that Committee members could meet together 
         information about the care of patients with asthma while       to discuss issues and reach consensus in a constructive 
         at the same time assuring a mechanism to incorporate           and timely manner. The members of the GINA Committees 
         the results of scientific investigations into asthma           are, however, solely responsible for the statements and 
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         care. Publications based on the GINA Report were               conclusions presented in this publication. 
         prepared and have been translated into languages to 
         promote international collaboration and dissemination of       GINA publications are available through the Internet 
         information. To disseminate information about asthma           (http://www.ginasthma.org). 
         care, a GINA Assembly was initiated, comprised of asthma 
         care experts from many countries to conduct workshops 
         with local doctors and national opinion leaders and to 
         hold seminars at national and international meetings. In 
         addition, GINA initiated an annual World Asthma Day (in 
         2001) which has gained increasing attention each year 
         to raise awareness about the burden of asthma, and to 
         initiate activities at the local/national level to educate     Eric Bateman, MD 
         families and health care professionals about effective         Chair, GINA Executive Committee 
         methods to manage and control asthma.                          University of CapeTown Lung Institute 
                                                                        Cape Town, South Africa
         ii