The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g. medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes.

GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting β₂-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS–formoterol reduces severe exacerbations by ≥60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA.

Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS–formoterol as the reliever at all steps: as needed only in Steps 1–2 (mild asthma), and with daily maintenance ICS–formoterol (maintenance-and-reliever therapy, "MART") in Steps 3–5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS–long-acting β₂-agonist (Steps 3–5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6–11 years, new treatment options are added at Steps 3–4.

Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.

全球哮喘倡议 (GINA) 战略报告为临床医生提供了每年更新的基于证据的哮喘管理和预防战略，该战略可以适应当地情况（例如药物供应）。本文总结了 GINA 2021 的主要建议，以及支持近期变化的证据。

GINA 建议成人和青少年哮喘不应单独使用短效 β ₂受体激动剂 (SABA) 治疗，因为仅使用 SABA 治疗和 SABA 过度使用的风险，以及吸入皮质类固醇 (ICS) 的益处的证据。大型试验表明，与单独使用 SABA 相比，按需联合 ICS-福莫特罗可将轻度哮喘的严重恶化减少 ≥60%，与每日 ICS 加按需 SABA 的恶化、症状、肺功能和炎症结果相似。

GINA 2021 的主要变化包括将成人和青少年的治疗数据分为两个轨道。Track 1（首选）在所有步骤中都使用低剂量 ICS-福莫特罗作为缓解剂：仅在步骤 1-2 中需要（轻度哮喘），以及每日维持 ICS-福莫特罗（维持和缓解治疗，“MART” ) 在步骤 3-5 中。Track 2（备选方案）在所有步骤中都有所需的 SABA，加上常规 ICS（步骤 2）或 ICS-长效 β _{2 -}激动剂（步骤 3-5）。对于患有中度至重度哮喘的成人，GINA 在第 5 步中提出了额外的建议，即附加长效毒蕈碱拮抗剂和阿奇霉素，以及附加生物疗法治疗重度哮喘。对于 6-11 岁的儿童，在步骤 3-4 中添加了新的治疗方案。

对于所有年龄组和严重程度，定期个性化评估、可改变风险因素的治疗、自我管理教育、技能培训、适当的药物调整和审查对于优化哮喘结果仍然至关重要。