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. 2019 Aug 14;20:183. doi: 10.1186/s12931-019-1159-y

Table 1.

Differences in recommended Step 1 and 2 controller options between GINA 2018 and 2019 [1, 25]

Controller options GINA 2018 GINA 2019

Step 1

 (Patients with symptoms <twice a month and no exacerbation risk factors)

 Preferred • SABA as-needed and no controller. • As-needed low dose ICS-formoterol (off- label).
Other options • Daily low dose ICS. • Low dose ICS taken whenever SABA is taken (off-label). This may involve combination (ICS-SABA) in a single or separate (ICS inhaler + SABA inhaler) inhaler/s.
Step 2 Preferred • Daily low dose ICS.

• Daily low dose ICS.

• As-needed low dose ICS-formoterol (off-label)
Other options

• Daily LTRA.

• Daily low dose ICS-LABA.

• Low dose ICS taken whenever SABA is taken (off-label)

• Daily LTRA.

• Daily low dose ICS-LABA (better improvement in symptoms and FEV1 than when ICS is used alone but more costly, and exacerbation rate is similar to the above option).

SABA = Short-acting beta2 agonist, LABA = Long-acting beta2 agonist, ICS=Inhaled corticosteroids, LTRA = Leukotriene receptor antagonist, FEV1 = Forced expiratory volume in one second

Note: (1) The new recommendations in GINA 2019 are highlighted in bold (2) The reliever option in GINA2019 is as-needed low dose ICS-formoterol or as-needed SABA