Dr Wechsler reviews key updates to the Global Initiative for Asthma (GINA) 2026, including the addition of combination therapies and new biologics, new assessment methods, inhaler techniques, and more. 

Michael Wechsler, MD, is Professor of Medicine at National Jewish Health and Director of the National Jewish Cohen Family Asthma Institute in Denver, Colorado.

2026 GINA Asthma Guideline Update: New Early Anti-Inflammatory Strategy, Biologic Additions, and Assessment Tools

• Asthma; Global Initiative for Asthma (GINA) 2026 update (May 2026): The annual guideline update, based on evidence from the prior 18 months of randomized clinical trials and observational studies, introduced new flow charts for asthma assessment, treatment, and follow-up, and emphasized anti-inflammatory reliever therapy with inhaled corticosteroid plus short-acting beta-agonist (SABA) at Step 1, reflecting evidence that asthma is both an inflammatory and bronchoconstrictive disease. The maintenance-and-reliever approach was reinforced across the asthma care continuum.

• Asthma biologics; FDA-approved therapies: The guideline added depemokimab, an ultra-long-acting anti–IL-5 biologic administered twice yearly, and included a generic anti-IgE therapy. A new table summarizes non-asthma indications for the four biologic classes (anti–IL-5, anti–IL-4, anti-TSLP, and anti-IgE), including chronic rhinosinusitis, nasal polyps, atopic dermatitis, urticaria, eosinophilic granulomatosis with polyangiitis, and hypereosinophilic syndrome.

• Clinical assessment, prevention, and add-on therapy: New guidance includes inhaler technique details (single-breath and tidal-breathing techniques with metered-dose inhalers and spacers), addition of the Chronic Airways Assessment Test, pediatric assessment tools, and a strong recommendation to use a validated clinical severity score for children with exacerbations. Updated evidence on influenza, RSV, and COVID-19 vaccines was incorporated. Observational data suggesting a potential future role for GLP-1 agonists in improving asthma outcomes were noted. Updated evidence indicated that triple therapy reduced severe exacerbations less than biologic therapy but may benefit adults and adolescents at GINA Step 5 who do not qualify for biologics.

Hi, I'm Dr. Michael Wechsler, Professor of Medicine at National Jewish Health and Director of the National Jewish Cohen Family Asthma Institute. I'm excited to talk to you today about an update to the 2026 Global Initiative for Asthma Guidelines.

The GINA guidelines are really a strategy for asthma management and prevention of asthma. And in May of 2026, there was an update provided to the GINA guidelines. The GINA guidelines are really published annually, every year since 2002. And the purpose of these guidelines is to provide some guidance to specialists and primary care practitioners and other health care providers in terms of reducing asthma morbidity, asthma mortality, and even reducing asthma prevalence.

These guidelines get updated pretty much every year, and they cover the prior 18 months of randomized clinical trials and observational studies that have been published. And this year, the guideline has some new updates that are important for clinicians and practitioners to learn about. This year, there were several new flow charts that were added regarding the assessment, treatment, and follow-up of patients with asthma. For each of these guidelines, there are some new important strategies that were included.

One of the key new additions was really a discussion of anti-inflammatory and reliever therapy with combination of inhaled steroids and short-acting beta agonists. This was added at step one of the guidelines. The reason for this type of addition is the growing of evidence that asthma isn't just a bronchoconstrictive disease that might benefit from bronchodilation with beta agonists, but also it's an inflammatory disease that might benefit from addition of an anti-inflammatory therapy. So utilizing a combination of an anti-inflammatory therapy with a bronchodilator early on in the treatment of asthma is important, even at step one. And to utilize this maintenance and reliever strategy for patients throughout the continuum of asthma was emphasized again.

It's also important that new biologics were added based on the approvals by the FDA. The biologics that were added were depemokimab, an ultra-long-acting anti-IL-5 therapy that's administered twice a year. And now there's also a generic anti-IGE therapy that will also be commercially available. And so that was also added onto this regimen and these guidelines.

There's a new table that was added that lists examples of some nonasthma indications for the current 4 classes of asthma biologic therapy. So now many of the asthma biologics—the anti-IL5s, anti-IL4, anti-TSLP, and anti-IG are approved for other indications, including chronic rhinosinositis, nasal polyps, atopic dermatitis, urticaria, and other indications, including eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome.

Some of the other things that were added to this year's guidelines include additional details about inhaler technique. And there were details provided regarding the single-breath techniques and tidal breathing techniques with mere dose inhaler and spacers.

And there are also some new tools that were added into this iteration of the guidelines, including the chronic airways assessment test. There's a pediatric asthma and impairment and risk questionnaire that has been added on top of the prior AirQ questionnaire. And there's a new pediatric respiratory assessment measure for children under 18 years who present with exacerbations; there's now a strong recommendation to use a validated clinical score for assessment of its severity.

Other updates that were included in this set of guidelines regarding vaccinations, and there's evidence that was updated regarding the effectiveness of influenza vaccines, RSV vaccines, and COVID-19 vaccines. And there's also a brief update regarding observational data on the potential future role of GLP-1 agonists; the glucagon-like peptide 1 agonists have been shown in some observational data to improve asthma outcomes, suggesting there might be a role in the future for those therapies as part of the asthma management.

There were, a few other additions—evidence about add-on long-acting antimuscarinic agents in adults and adolescents in GINA step 5 was updated. It was noted that the reduction of severe exacerbations with triple combinations therapy compared to just inhaled LABA therapy was far less than the reductions achieved with biologic therapy, but triple therapy may be useful in patients who don't qualify for biologics.

So there are other additions as well. The guidelines really provide guidance to us as practitioners. They aren't hard and fast rules, but they are evidence-based and they really help with the asthma management of our patients. And I think they've resulted over the years in significant improvement in morbidity associated with our management of asthma.

So I encourage you to go to the GINA guidelines. You can access them online by just searching for the GINA strategy report or the global strategy for asthma management and prevention report. And that will give you the extensive update. There's also a section which highlights the recent changes. So I think it'll help your patients and provide some benefits to them. And we'll also educate you a little bit on the latest updates in asthma management. So thanks so much for listening today, and we look forward to our next segment in this program.