Lecture Notes: GINA Asthma Guidelines for Nurse Practitioners

Introduction

• Objective: Break down GINA (Global Initiative for Asthma) guidelines to boost confidence for board exams.
• Importance: GINA guidelines are a frequent topic on nurse practitioner board exams.

Overview of GINA Guidelines

• Purpose: Provide a framework for managing asthma.
• Approach: Step-up treatment based on symptom severity and frequency.
• Steps:
  • Step 1: Symptoms less than twice a month.
  • Step 2: Symptoms more than twice a month but not daily.
  • Step 3: Symptoms on most days or waking up with asthma once a week or more.
  • Steps 4 & 5: Similar to Step 3 with low lung function (low FEV1 percentage).

Detailed Breakdown

Step 1

• Severity: Mildest category.
• Medication: As-needed low-dose ICS-Formoterol.
  • ICS-Formoterol: Combination of inhaled corticosteroid (ICS) and long-acting beta agonist (LABA).
  • Formoterol: Quick-acting, used as a rescue inhaler.
• Controller Options: Tailored to individual needs.

Step 2

• Preferred Controller: Daily low-dose ICS or as-needed ICS-Formoterol.
• Other Options: Daily leukotriene receptor antagonist or low-dose ICS with SABA.
• Preferred Reliever: As-needed low-dose ICS-Formoterol.

Step 3

• Recommended Treatment: Low-dose ICS-LABA.
• Other Options: Medium-dose ICS or low-dose ICS with leukotriene receptor antagonist.
• Preferred Reliever: As-needed low-dose ICS-Formoterol.

Step 4

• Recommended Treatment: Medium-dose ICS-LABA.
• Other Options: High-dose ICS, add tiotropium or leukotriene receptor antagonist.
• Preferred Reliever: As-needed low-dose ICS-Formoterol.

Step 5

• Note: Severe asthma, typically managed by a specialist; not covered in primary care.

Key Principles of GINA Guidelines

1. Assess symptom severity.
2. Understand step-up treatment as needed.
3. Combine medications for additive benefits.
4. Monitor and adjust treatment regularly.

Conclusion

• Further Resources: Consider enrolling in a full online course for comprehensive preparation.
• Call to Action: Visit theenreview.com for more resources and exam strategies.