2026 Global Initiative for Asthma (GINA) Strategy Report: Executive Summary and Key Changes

Abstract The Global Initiative for Asthma (GINA) Strategy Report provides a comprehensive, annually updated evidence-based approach to asthma diagnosis, assessment, treatment, and prevention across the lifespan. Its central approach is personalized, iterative care based on the Assess-Adjust-Review cycle for both symptom control and reduction of future risk (including severe exacerbations, persistent airflow limitation, and treatment-related harm). GINA emphasizes objective confirmation of diagnosis wherever possible, and regular assessment of lung function, inhaler technique, adherence, multimorbidity, risk factors (including Type-2 biomarkers), and patient goals and preferences. GINA strongly recommends that all adults, adolescents, children and most preschoolers with asthma should receive inhaled corticosteroid (ICS)-containing treatment. GINA recommends against short-acting beta2-agonist (SABA)-only treatment. For adults/adolescents, GINA Track 1 using low-dose ICS-formoterol, an anti-inflammatory reliever (AIR), either as-needed-only (AIR-only) or as maintenance-and-reliever therapy (MART), is preferred because of its substantial reduction in severe exacerbations compared with SABA-based regimens, and its simplicity. Age-specific treatment pathways in children also emphasize ICS-containing therapy and exacerbation prevention. For difficult-to-treat and severe asthma, GINA provides structured guidance, emphasizing diagnostic verification, optimization of modifiable factors, inflammatory phenotyping, biologic therapy selection, and (as for all patients) systemic corticosteroid stewardship. Acute exacerbation care incorporates long-term preventive treatment, including post-discharge reassessment of management and action plan. Key 2026 updates include expanded AIR options for adults and children, revised guidance on severe asthma and selection of biologic treatment, and substantial updates to acute asthma management. GINA integrates evidence-based management with shared decision-making, self-management education, implementation, and global advocacy to reduce preventable asthma morbidity and mortality.