Rationale for change
Previous GINA reports have presented recommendations about written asthma action plans within the
context of asthma education, and separate from treatment of acute asthma in primary care or acute care
settings. Based on feedback received from clinicians, these topics have been brought together into a single
chapter in the GINA report, to provide a continuum for treatment and follow-up. A review of evidence led
to new recommendations being provided about increasing controller therapy in action plans, initiating (or
recommencing) ICS after severe exacerbations, and oxygen saturation targets. To enhance utility for
8 DOI: 10.1183/13993003.00853-2015
ASTHMA CONTROL | H.K. REDDEL ET AL.
development of clinical pathways, recommendations about management of exacerbations in primary care
and acute care are summarised in new flow charts.
The term “flare-up” is now recommended for communication with patients. Although the term
“exacerbations” is standard in medical literature, it is far from patient-friendly. “Attacks” is commonly
used, but with such different meanings that it may cause misunderstandings [54]. For patients, the term
“flare-up” was recommended, as it conveys the concept of inflammation, and signals that asthma is present
even when symptoms are absent. Similar issues should be considered when recommendations are
translated into other languages.