Pulmonology AdvisorGINA 2026 Update: Asthma Management in Primary Care, Biologic Updates, and More

✅ Guideline Update

The Global Initiative for Asthma (GINA) released its 2026 strategy update on May 5, adding new exacerbation management flowcharts for primary care and acute care settings across all age groups — including a dedicated pathway for children aged 5 years and younger — along with updated biologic selection guidance and OCS minimization recommendations.

Clinical Considerations

• New age-stratified flowcharts stratify management by mild, moderate, and severe/life-threatening presentation; ICS-formoterol is preferred over SABA-only therapy for mild exacerbations in patients aged 12 and older.
• A formal red-flag list for fatal/near-fatal asthma risk includes prior intubation, SABA overuse, ICS nonadherence, psychiatric history, food allergy or anaphylaxis history, and comorbidities including pneumonia and arrhythmias.
• Depemokimab is now included in biologic recommendations for severe eosinophilic asthma (age 12+) and CRSwNP (age 18+); an updated decision tree incorporates type 2 inflammation markers, comorbidities, dosing frequency, and patient preference.
• Sedation is explicitly contraindicated during exacerbations due to respiratory depressant effects and association with avoidable asthma deaths.
• SABA toxicity in young children such as but not limited to tachycardia, hypokalemia, and lactic acidosis, is flagged as a risk that may be mistaken for worsening asthma, driving inappropriate dose escalation.

Practice Applications

• Integrate the new primary care flowcharts into exacerbation triage workflows for both adult/adolescent and under-5 populations.
• Screen all patients with severe asthma against the red-flag list at each visit; prioritize ICS adherence counseling and inhaler technique review before discharge.
• Consider GLP-1RA use in patients with obesity and asthma as early evidence suggests reduced exacerbation rates, though prospective data are pending.
• Follow local immunization schedules for influenza, RSV, COVID-19, pneumococcal, and pertussis vaccination in all pediatric asthma patients.