At SCHILLER, we understand that your time is valuable and that keeping up with clinical guidelines can be a challenging task. That’s why we prepared this summary highlighting the most important updates in the 2025 edition of the GINA (Global Strategy for Asthma Management and Prevention) Strategy Report. We want to help you quickly identify the new recommendations and, most importantly, what is no longer advised in asthma management.
We’re committed to supporting your daily practice with up-to-date, practical information. Read and share this summary with your team and colleagues.
By América Torres
Interpretation of type 2 inflammation biomarkers
In the 2025 edition of the GINA Guidelines1, the authors give greater importance to Type 2 inflammation biomarkers and reference them throughout the document. They specifically address these biomarkers in Appendix A.
This appendix states that clinicians should always interpret Type 2 inflammation biomarkers in patients with asthma (measured in blood, urine, induced sputum, exhaled air, and bronchoalveolar lavage) within an appropriate clinical context. For asthma management, the most useful biomarkers are those indicating Type 2 airway inflammation and allergy, such as:
- Blood eosinophil count
- Fractional exhaled nitric oxide (FeNO)
- Total serum immunoglobulin E (IgE)
- Allergen-specific IgE
According to the document, clinicians can use these biomarkers to support diagnosis, identify phenotypes, monitor disease, assess prognosis, and predict patient response to asthma treatment. It also notes that sputum eosinophil count can guide corticosteroid therapy in patients with moderate to severe asthma, although this test is not commonly available in clinical practice.
Risk factors for severe exacerbations in adolescent and adult patients
The ORACLE22 study supports GINA’s recommendation to assess multiple factors—including type 2 biomarkers—to estimate the risk of exacerbations. The researchers analyzed data from patients in the placebo groups of clinical trials. They could not assess SABA (short-acting beta2-agonist) overuse due to lack of data. Similar studies are needed in real-world populations, along with risk-reduction strategies based on the identified factors. The study also highlights the important role of environmental factors, such as air quality, in reducing exacerbations.
GINA 2025 addresses the impact of climate change on asthma
The GINA 2025 Report addresses the impact that climate change and extreme weather events (such as heatwaves, cold spells, heavy rainfall, and droughts) have on people with asthma. It groups the negative effects of climate into two main categories:
- Infrastructure. Climate-related disasters can damage healthcare infrastructure, potentially disrupting access to medical care.
- Air pollution. The presence of air pollutants, the survival of respiratory viruses, and the increased concentration of allergens in the air can worsen asthma. The document also notes that thunderstorms may trigger asthma exacerbations and even epidemic outbreaks.3
Diagnostic criteria in children aged 5 years and younger
The 2025 edition of the GINA Report confirms that clinicians can diagnose asthma in this age group and clearly outlines the three criteria they must meet:
- Recurrent acute episodes of wheezing, or at least one acute episode of wheezing accompanied by asthma-like symptoms between episodes.
- No other likely alternative cause for the respiratory symptoms.
- Timely clinical response of respiratory signs or symptoms to asthma treatment. Any of the following options:
- Rapid response to SABA (short-acting beta2-agonist) during acute wheezing episodes in a healthcare setting (within minutes), or, in more severe cases, within 3–4 hours after starting treatment with SABA and oral corticosteroids (OCS).
- Rapid response to SABA at home, with symptom improvement within minutes.
- Decrease in the frequency or severity of acute wheezing episodes and/or symptoms between episodes during a 2–3 month diagnostic trial with daily inhaled corticosteroids (ICS).
To establish a diagnosis of asthma in this age group, all three criteria above must be met. If only one or two are met, it should be recorded as suspected asthma.
Treatment of asthma in children aged 5 years and younger
The GINA Strategy Report 2025 updates the therapeutic approach to asthma in children under 5 years of age with a confirmed diagnosis (see treatment figure). It highlights the limited availability of options for children who present asthma symptoms on ≤2 days per week and have no history of severe episodes. Researchers are currently investigating new treatment alternatives. One of them is low-dose ICS-formoterol as an anti-inflammatory reliever therapy in this age group.
Exacerbations in children aged 5 years or younger: new saturation threshold, nebulized magnesium
- The recommendation to use intravenous magnesium sulfate in moderate or severe exacerbations is reinforced.
- The document discourages the use of nebulized magnesium sulfate.
- The Guides now include new dosing instructions for inhaled medications used during intensive care.
- The target oxygen saturation changes from 94–98% to ≥94%, with a reminder to consider skin color and to make altitude adjustments if relevant (for this and all age groups).
Biomarkers for the diagnosis of asthma in adults and adolescents
- The authors revised the diagnostic algorithm for asthma in adults and adolescents to make it clearer. They also added the limited role of biomarkers (see Appendix A).
- Lung function assessment remains the first choice to confirm the diagnosis.
New definition of asthma
The authors replaced the term “variable expiratory flow limitation” with “variable expiratory flow” because the original term caused confusion. GINA indicates that in untreated asthma patients, lung function varies, so airflow limitation may be present at times and absent at others. The document clarifies that GINA has never intended to imply that airflow limitation must be present during diagnostic evaluation.
Relevance of elevated FeNO
The authors added the indication “Consider biomarkers” to the “Review” section of the asthma management cycle chart. GINA notes that FeNO suppression studies have shown that, in many patients, elevated FeNO levels are due to poor adherence to inhaled corticosteroid (ICS) treatment. Therefore, it is better to consider biomarkers after starting such treatment to assess adherence and inhalation technique.
Population-based and personalized treatment decisions
Since 2014, the GINA recommendations have grounded population-based decisions in reliable group evidence. For individual decisions, physicians should consider phenotypic characteristics (including biomarkers), comorbidities, patient perspectives, and practical aspects.
Fenoterol is no longer recommended. New dosage for fluticasone furoate and for ICS-LABA combinations
- The Guide added fenoterol to the list of bronchodilators not recommended due to its high risk of causing adverse cardiovascular effects and asthma-related mortality.
- GINA 2025 maintains the two-track treatment strategy for adolescents and adults, prioritizing Track 1 with ICS-formoterol as the anti-inflammatory reliever medication (when available), since it reduces the risk of severe exacerbations, corticosteroid exposure, and urgent care needs compared to SABA (Short-Acting Beta 2-Agonist)-based regimens.
- In Track 2, Step 4 has changed from medium-to-high dose ICS-LABA to medium dose ICS-LABA (Inhaled corticosteroid Long-acting beta 2-agonist) to minimize adverse effects associated with high doses of ICS. If high-dose ICS-LABA is needed, its use should be limited to 3–6 months whenever possible.
- The authors reclassified the daily doses of fluticasone furoate: 100 mcg as low-medium and 200 mcg as medium-high.
- In the GINA 2025 edition, the “other controller options” that previously appeared in gray boxes under each step (p. 77) were removed. The authors replaced these options, which had lower evidence of efficacy and/or safety, with explanatory text. The goal is to prevent delays in referring patients with difficult-to-control asthma to a specialist by avoiding trials of multiple additional treatments without proven effectiveness.
Shared decision-making for inhaler choice
The GINA Strategy Report 2025 updates its approach to inhaler selection by emphasizing that the priority is to choose the most appropriate medication for the patient. Only if the medication is available in multiple devices that the patient can use correctly should the environmental impact be considered as an additional factor in the shared decision-making process.
Changes in asthma treatment action plans
- For patients using conventional treatment based on SABA (Track 2), the use of SABA to relieve symptoms is increased.
- There is only limited evidence that doubling or quadrupling the maintenance dose of inhaled corticosteroids (ICS) reduces progression to a severe exacerbation defined as the need for oral corticosteroids (OCS).
- In contrast, for patients using ICS-formoterol as anti-inflammatory rescue medication (Track 1), the usual maintenance dose is continued, but rescue doses are increased as needed to control the increase in inflammation and bronchoconstriction. In this case, there is strong evidence of a significant reduction in the risk of severe exacerbations requiring OCS or urgent medical care.
Treatment of severe exacerbations in adults, adolescents, and children aged 6 to 11 years
- The document specified SABA doses for initial treatment in primary care and emergency services to prevent excessive use.
- It no longer recommends using nebulized magnesium.
Spirometry is a reliable test for diagnosing asthma
The Global Strategy for Asthma Management and Prevention (GINA) states that spirometry is a reliable tool to assess lung function. This test measures key parameters such as forced expiratory volume in the first second (FEV1) and the FEV1/FVC ratio (forced vital capacity). Additionally, GINA emphasizes that trained personnel should perform spirometry using well-maintained, properly calibrated equipment and filters that prevent infection transmission.This is where SpiroScout makes the difference.
This state-of-the-art spirometer not only meets GINA requirements—it exceeds them. Thanks to its SharpFlow ultrasonic technology, SpiroScout requires no calibration, ensuring precise and reliable measurements. Its intuitive design makes it easy to use, allowing staff to operate the device with a minimal learning curve.
Regarding biosafety, SpiroScout offers a double layer of protection:
- The ScoutTube mouthpieces, which feature a protective membrane to prevent cross-contamination.
- And for maximum safety, the system includes the SpiroDef, a filter that effectively eliminates aerosols, bacteria, and viruses, ensuring total hygiene.
Additionally, the LFX software that accompanies SpiroScout (and all our pulmonary function tests) provides valuable clinical features:
- Automatically verifies if the test meets the quality criteria established by ATS/ERS.
- Includes visual graphics (candles, fish, and clouds) to make the test more friendly for children and guide them to perform the maneuver correctly.
- LFX also enables the comparison of multiple tests to objectively evaluate the patient’s response to treatment.
We invite you to watch this short video that explains the differences between oscillometry and spirometry, and the advantages of each test.
Asthma diagnosis from age 4 onwards
According to GINA, in children, spirometry cannot be reliably obtained until the age of 5 years or older. That is why SCHILLER-GANSHORN developed the tremoflo®, our airway oscillometer. It allows pulmonary function assessment in very young children, starting from 4 years of age.
Discover the advantages of oscillometry for performing reliable tests in young patients.
This method is also useful for patients with neurological problems or difficulty performing the spirometry maneuver.
At SCHILLER-GANSHORN, we offer a complete line of pulmonary function tests for diagnosing and monitoring patients with asthma, COPD, and other respiratory diseases. As the first manufacturer to implement ultrasound technology across our entire PFT line, we continue to lead through innovation, delivering precise, user-friendly solutions that elevate clinical care.
Working with innovators means staying ahead. By partnering with SCHILLER-GANSHORN, you gain access to cutting-edge technology backed by decades of expertise in respiratory diagnostics. We invite you to schedule a personalized consultation with one of our specialists. During this session, you’ll explore the SpiroScout spirometer and the tremoflo® oscillometer, share your practice’s needs, and receive expert guidance to help you choose the best-fit equipment. The consultation is completely free and without obligation. Book a one-on-one session today!
Improve Pulmonary Diagnosis with Our Free SpiroScout Trial
With the SCHILLER Trial Program, you can test the SpiroScout in your own clinical setting and see how easily it fits into your workflow. Discover how it can boost diagnostic accuracy, elevate patient care, and support practice growth—on your terms.
What’s included:
15 business days of hands-on use
Free shipping
Remote installation and training by our experts
No commitment required—if it’s not right for you, simply send it back. If it is, you can move forward with total confidence. Available exclusively in the U.S. Find out what SpiroScout can do for your practice!
REFERENCES
[1] Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Updated May 2025. Available from: www.ginasthma.org
[2] Meulmeester FL, et al. Inflammatory and clinical risk factors for asthma attacks (ORACLE2): a patient-level meta-analysis of control groups of 22 randomised trials. Lancet Respir Med. 2025 Jun;13(6):505-516. DOI: 10.1016/S2213-2600(25)00037-2 Epub 2025 Apr 8. PMID: 40215991; PMCID: PMC12117016.
[3] Dwan Price PhD et al. Epidemic Thunderstorm Asthma: Lessons Learned from the Storm Down-Under. The Journal of Allergy and Clinical Immunology: In Practice Volume 9, Issue 4, April 2021, Pages 1510-1515. DOI: https://doi.org/10.1016/j.jaip.2020.10.022