Comparing Global Initiative for Asthma guideline approaches to asthma control in adolescents aged 12 and above

The Global Initiative for Asthma (GINA) guidelines for asthma management in children and adolescents aged 12 years and older present two treatment tracks. Track 1, the preferred option, involves as-needed low-dose inhaled corticosteroids (ICS) combined with formoterol. Track 2 involves as-needed ICS with a short-acting β-agonist for step 1 and low-dose maintenance ICS for step 2. This study aimed to compare the effectiveness of Track 1 and Track 2 in managing asthma in pediatric patients aged 12 years or older. This was a retrospective study that was conducted at Aga Khan University Hospital in Karachi, Pakistan, from January 1, 2022, to December 31, 2023. The study included children and adolescents aged 12 years or older, diagnosed with asthma exacerbations, who were discharged on reliever therapy following the GINA guidelines for steps 1 and 2. Patients were followed for re-admission within 30 days, emergency room (ER) visits, annual admissions, length of stay, and the need for intensive care. Pulmonary function tests (PFTs) were performed at 1 week and 3 months post-discharge. A total of 90 patients were enrolled and divided into Track 1 (n=43) and Track 2 (n=47). Track 1 patients had significantly fewer readmissions (4.65% vs. 19.15%, p=0.036), fewer ER visits (1.69±1.31 vs. 2.8±1.37, p<0.001), and fewer hospital admissions (1.37±0.85 vs. 2.1±0.84, p<0.001). Track 1 patients also required less intensive care (9.3% vs. 27.66%, p=0.034). PFTs showed greater improvement in forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity ratio for Track 1 compared to Track 2 at three months (p=0.026 and p<0.001, respectively). The study found that treatment with as-needed ICS/formoterol (Track 1) was more effective in managing asthma compared to the alternative treatment strategies in Track 2.