Adherence to GINA Guidelines in Asthma Pharmacotherapy: A Review of Medication Utilization Patterns and Determinants

Abstract

Asthma is common, chronic, and, for the most part, manageable, yet the gap between what current guidelines recommend and what patients actually receive has proved surprisingly stubborn. The Global Initiative for Asthma (GINA) strategy has changed considerably over the last decade, moving away from reliever-only treatment for mild disease toward early anti-inflammatory therapy for everyone. This review looks at how well that shift has actually been adopted in practice, drawing on international studies as well as the more limited body of Indian work on asthma prescribing. A recurring finding across settings is that short-acting beta-agonists continue to be overused, inhaled corticosteroids are prescribed inconsistently, and oral corticosteroid courses are sometimes repeated without adequate scrutiny of cumulative risk. Some of this can be traced to patients, particularly poor inhaler technique and inconsistent day-to-day adherence, and some to prescribers, who may be only partly familiar with the newer track-based GINA framework or simply pressed for time. Indian data on the subject exist but are thin, geographically patchy, and rarely benchmarked against the specific GINA track and step in effect at the time. Puducherry and the surrounding region are a particular blind spot despite having tertiary hospitals well placed to generate this evidence. This review sets out that background and argues, on the strength of it, for a retrospective evaluation of asthma medication utilization measured explicitly against GINA recommendations.