GINA Charts

Question 1

Preferred, 12+ yrs, step 1

Answer 1

PRN low dose ICS-formoterol

Question 2

Preferred, 12+ yrs, step 2

Answer 2

PRN dose ICS-formoterol

Question 3

Preferred, 12+ yrs, step 3

Answer 3

Low dose ICS-formoterol

Question 4

Preferred, 12+ yrs, step 4

Answer 4

Medium dose ICS-formoterol

Question 5

Preferred, 12+ yrs, step 5

Answer 5

Add on LAMA, Refer to phenotype

High dose ICS-formoterol, ± anti-IgE, ± anti-IL5/5R, ± anti-IL4R, anti-TSLP

Question 6

Alternative, 12+ yrs, step 1

Answer 6

Take ICS whenever SABA taken

Question 7

Alternative, 12+ yrs, step 2

Answer 7

Low dose ICS

Question 8

Alternative, 12+ yrs, step 3

Answer 8

Low dose ICS-LABA

(Advair 100/50)

Question 9

Alternative, 12+ yrs, step 4

Answer 9

Med/high dose ICS-LABA

(Advair 250/50 or 500/50)

Question 10

Alternative, 12+ yrs, step 5

Answer 10

Add on LAMA, Refer to phenotype

High dose ICS-formoterol, ± anti-IgE, ± anti-IL5/5R, ± anti-IL4R, anti-TSLP

Question 11

Preferred reliever for 12+

Answer 11

PRN low dose ICS-formoterol

Question 12

Alternative reliever for 12+

Answer 12

PRN SABA or ICS-SABA

Question 13

Other controllers options for 12+, step 2

Answer 13

Low dose ICS, whenever SABA taken, or QD LTRA or add HDM SLIT

Question 14

Other controllers options for 12+, step 3

Answer 14

Medium dose ICS, or add HDM SLIT, or add LTRA

Question 15

Other controllers options for 12+, step 4

Answer 15

Add LAMA or LTRA or HDM SLIT, or switch to high dose ICS

Question 16

Other controllers options for 12+, step 5

Answer 16

Add azithromycin or LTRA.

Last resort OCS

Question 17

Preferred, 6-11 yrs, step 1

Answer 17

Low ICS whenever with SABA

Question 18

Preferred, 6-11 yrs, step 2

Answer 18

QD low ICS

Question 19

Preferred, 6-11 yrs, step 3

Answer 19

Low dose ICS-LABA,
or Medium dose ICS,
or Very low dose ICS-formoterol MART

Question 20

Preferred, 6-11 yrs, step 4

Answer 20

Medium dose ICS-LABA,
or Low dose ICS-formoretol MART

Refer to expert for advice

Question 21

Preferred, 6-11 yrs, step 5

Answer 21

Refer to phenotypic assessment.

±higher dose ICS-LABA, or add-on anti-IgE, ± anti-IL5/5R, ± anti-IL4R

Question 22

Alternative, 6-11 yrs, step 1

Answer 22

Consider QD low ICS

Question 23

Alternative, 6-11 yrs, step 2

Answer 23

QD LRTA or low dose ICS whenever with SABA

Question 24

Alternative, 6-11 yrs, step 3

Answer 24

Low dose ICS+LTRA

Question 25

Alternative, 6-11 yrs, step 4

Answer 25

Low dose ICS+LTRA

Add tiotropium or add LTRA

Question 26

Alternative, 6-11 yrs, step 5

Answer 26

low dose OCS

Question 27

Reliever for 6-11 years

Answer 27

PRN SABA or ICS-formoterol in MART in steps 3-4

Question 28

Preferred, 5> yrs, stage 1

Answer 28

N/A

Question 29

Preferred, 5> yrs, stage 2

Answer 29

QD low dose ICS

Question 30

Preferred, 5> yrs, stage 3

Answer 30

Double low dose ICS

Question 31

Preferred, 5> yrs, stage 4

Answer 31

COntinue controller and refer to specialist

Question 32

Other options, 5> yrs, stage 1

Answer 32

Short course ICS at onset of viral illness

Question 33

Other options, 5> yrs, stage 2

Answer 33

QD LTRA or intermittent short course of ICS at onset of respiratory illness

Question 34

Other options, 5> yrs, stage 3

Answer 34

Low dose ICS+LTRA
Consider specialist referral

Question 35

Other options, 5> yrs, stage 4

Answer 35

Low dose ICS+LTRA
Add LTRA, or increase ICS frequency, or add intermittent ICS

Question 36

Consideration for step 1 5> children

Answer 36

Infrequent viral wheezing and no/few interval symptoms

Question 37

Consideration for step 2 5> children

Answer 37

Symptoms not consistent with asthma but wheezing requiring SABA

Question 38

Consideration for step 3 5> children

Answer 38

Asthma diagnosis and asthma not well controlled on low dose ICS

Question 39

Consideration for step 4 5> children

Answer 39

Asthma not well controlled on double ICS

Question 40

Consideration for step 3 and 4 5> children

Answer 40

Before stepping up, check for alternative diagnosis check inhaler skills, and review adherence and exposures