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Asthma

GMJ News knowledge hub · last reviewed August 2026 · Georgian Medical Journal

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Asthma — a chronic inflammatory airway disease characterised by reversible bronchospasm, airway hyper-responsiveness and mucus overproduction — affects an estimated 262 million people globally and causes approximately 455,000 deaths per year, the vast majority of which are preventable with appropriate controller therapy (inhaled corticosteroids), representing one of the most striking examples of a treatable condition still causing avoidable mortality due to access barriers and underdiagnosis (WHO). The 2023 GINA (Global Initiative for Asthma) guidelines overturned decades of standard practice by recommending against salbutamol (SABA) monotherapy — and towards ICS-formoterol (inhaled corticosteroid plus fast-acting bronchodilator) as the preferred reliever — while the biologics revolution (dupilumab, mepolizumab, tezepelumab, omalizumab) is transforming the management of severe refractory asthma.

Key messages

262M affected — 455K preventable deaths/year
262 million people have asthma globally; 455,000 die per year — the vast majority preventable with inhaled corticosteroids (ICS). Most asthma deaths occur in low-income countries without ICS access (WHO).
GINA 2023 — no SABA monotherapy any more
The 2023 GINA guidelines reversed decades of practice: salbutamol (SABA) alone as a reliever is no longer recommended for any step. ICS-formoterol (e.g. budesonide-formoterol) is now the preferred reliever across all severity steps — reducing exacerbations and deaths.
ICS — the cornerstone of control
Inhaled corticosteroids (beclomethasone, budesonide, fluticasone) are the most effective controller therapy, reducing airway inflammation, exacerbations, hospitalisations and deaths. Most asthma is controllable with low-to-medium ICS doses.
Biologics revolution for severe asthma
For severe refractory eosinophilic asthma: mepolizumab, benralizumab (anti-IL-5); dupilumab (anti-IL-4/IL-13 — also treats atopic dermatitis, allergic rhinitis, CRSwNP); tezepelumab (anti-TSLP — broadest spectrum); omalizumab (anti-IgE — allergic asthma). These biologics reduce exacerbations by 50-70% in severe asthma.
Asthma is not the same as COPD
Asthma: typically reversible airflow obstruction; onset often in childhood; allergic component common; responds excellently to ICS. COPD: largely irreversible; onset in middle-to-older age; smoking the dominant cause; progressive. Overlap exists (Asthma-COPD Overlap, ACO). Distinguishing the two directs very different treatment.
Georgia and indoor air quality
Occupational asthma (isocyanates, flour, latex, wood dust) and domestic biomass burning are important asthma triggers in Georgian contexts. WHO essential medicines include salbutamol and budesonide — both should be accessible in all healthcare settings.

Key statistics

262M
people with asthma globally (WHO 2019)
WHO
455K
asthma deaths/year — most preventable
WHO
2023
year GINA guidelines abandoned SABA monotherapy
GINA 2023
50-70%
exacerbation reduction with biologic therapy in severe asthma
NEJM/Lancet
80%
of asthma deaths occur in low- and middle-income countries
WHO
ICS+formoterol
preferred reliever and controller at all GINA steps (2023)
GINA 2023

GINA 2023 asthma treatment steps — reliever and controller at each step

Source: GINA 2023. ICS-formoterol replaces SABA monotherapy at all steps.

Glossary of key terms

SABA (short-acting beta-2 agonist)
WHO/GINASalbutamol (albuterol) and terbutaline — rapid-onset bronchodilators used for acute symptom relief. Previously recommended as the sole reliever for all asthma severities. GINA 2023: SABA alone is no longer safe as the only reliever — because regular SABA without ICS increases asthma mortality. ICS-formoterol is now preferred.
ICS (inhaled corticosteroids)
WHO/GINABeclomethasone, budesonide, fluticasone, ciclesonide — reduce airway eosinophilic inflammation (the core pathological process in allergic/eosinophilic asthma). The most evidence-based asthma controller therapy. Available in pressurised metered-dose inhalers (pMDI) and dry powder inhalers (DPI). On WHO Essential Medicines List.
SMART therapy
GINA/ERSSingle Maintenance And Reliever Therapy — using ICS-formoterol (e.g. budesonide-formoterol, Symbicort/Vannair) as BOTH the daily controller AND the as-needed reliever. Reduces severe exacerbations versus fixed-dose ICS-LABA + SABA in clinical trials. The principle underlying GINA's anti-SABA stance.
Biologic therapies for severe asthma
ERS/GINAFor GINA Step 5 severe refractory asthma: omalizumab (anti-IgE — allergic asthma, ≥6yr); mepolizumab (anti-IL-5 — eosinophilic); benralizumab (anti-IL-5Rα — eosinophilic); dupilumab (anti-IL-4Rα — eosinophilic, also treats atopic dermatitis and CRSwNP); tezepelumab (anti-TSLP — broadest; works in non-eosinophilic asthma too).
Airway hyperresponsiveness
GINAAn exaggerated bronchoconstrictor response to stimuli that do not affect normal airways — cold air, exercise, inhaled allergens, smoke, viral infections, emotional stress. The hallmark physiological abnormality of asthma. Measured by methacholine challenge test (PC20 <8mg/mL = positive). ICS reduces airway hyperresponsiveness over weeks.
Asthma triggers
WHOCommon triggers: allergens (house dust mite — the most important; pet dander; pollen; mould); air pollution (PM2.5, ozone, NO2); cold air and exercise; tobacco smoke (active or passive); viral URTIs (rhinovirus — the most common trigger of acute exacerbations); aspirin/NSAIDs (approximately 10% of adults with asthma — Samter's triad with nasal polyps); occupational exposures.

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Related health topics

COPDChronic respiratory diseasesAllergiesAtopic dermatitisAir pollutionOccupational asthma

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