GINA 2026 Asthma Guidelines: Quick Reference
The bottom line of the GINA 2026 asthma strategy for adults and adolescents: confirm the diagnosis, never treat with a short-acting beta-agonist alone, prefer as-needed ICS-formoterol as the reliever, and refer uncontrolled severe asthma for phenotyping and biologic therapy.
At a glance
- Confirm asthma with evidence of variable airflow limitation, ideally before starting controller treatment.
- Do not treat adults or adolescents with a short-acting beta-agonist (SABA) alone; every regimen should contain an inhaled corticosteroid.
- Preferred approach (Track 1): low-dose ICS-formoterol as needed for mild asthma, and as maintenance-and-reliever therapy from Step 3.
- Before stepping up, check inhaler technique, adherence, comorbidities and exposures.
- Give every patient a written action plan; refer severe asthma for phenotyping and consideration of biologics.
Key recommendations
Diagnosis
Document variable expiratory airflow limitation (for example bronchodilator responsiveness on spirometry or variable peak flow), ideally before starting ICS, because it is harder to confirm afterwards.
Starting treatment
Do not use SABA-only treatment in adults and adolescents; it raises the risk of severe exacerbations and asthma death.
Evidence: Evidence AFor mild asthma (Steps 1 and 2), use low-dose ICS-formoterol as needed for symptom relief (anti-inflammatory reliever).
Evidence: Evidence AIf ICS-formoterol is not possible (Track 2), pair a SABA reliever with regular low-dose ICS, or with ICS taken every time the SABA is used.
Stepping up
From Step 3, use ICS-formoterol as both maintenance and reliever therapy (MART), moving to medium dose at Step 4.
Evidence: Evidence ABefore any step up, check inhaler technique and adherence, and look for comorbidities and ongoing exposures such as smoking.
Severe asthma
For asthma uncontrolled at Step 4 or 5, add a long-acting muscarinic antagonist and refer for phenotyping.
For severe type 2 asthma, consider a biologic (anti-IgE, anti-IL-5 or IL-5 receptor, anti-IL-4 receptor alpha, or anti-TSLP) chosen by biomarkers and history; avoid long-term oral corticosteroids where possible.
Self-management
Give every patient a written asthma action plan and teach inhaler technique; review control and risk at every visit.
Stepping down
Once asthma has been well controlled for about 3 months, consider stepping down to the lowest effective treatment, but do not stop ICS completely.
Exacerbations
Treat acute asthma with a rapid-acting bronchodilator, early systemic corticosteroids for moderate to severe attacks, and controlled oxygen to a target saturation; arrange follow-up within days.
How to read the grades GINA
Evidence A: randomized trials and meta-analyses with a rich body of data. B: randomized trials and meta-analyses with a limited body of data. C: nonrandomized trials or observational studies. D: panel consensus.
What changed
Compared with the GINA 2025 report.
Acute asthma
- Before
- SABA-based relief was standard in acute care.
- Now
- Further reduces reliance on SABA during exacerbations and widens the role of ICS-formoterol.
Oxygen
- Before
- Oxygen to a target saturation in acute asthma.
- Now
- Updated oxygen saturation targets.
Biologics
- Before
- Biologics for severe type 2 asthma.
- Now
- New biologic options added for severe asthma.
Children
- Before
- Diagnosis and treatment guidance for children 6 to 11 and 5 and younger.
- Now
- Updated diagnosis and acute asthma guidance in children.
EvidencePulse
Does this apply to my patient?
Pick a question or write your own. EvidencePulse answers from the studies, with citations.
2MM+The studies behind each recommendation
Read our physician-written summaries of the trials these recommendations rest on. 2MM+ includes unlimited articles, EvidencePulse and HypeCheck.
Get an alert when this guideline changes
Free in the 2MM Daily Brief: what changed, in our own words, the day it comes out.
Opens Mailchimp to confirm. Unsubscribe anytime.
Questions clinicians ask
Why doesn't GINA recommend a SABA inhaler alone anymore?
Using a short-acting beta-agonist without an inhaled corticosteroid increases the risk of severe exacerbations and asthma death. GINA recommends that every adult and adolescent with asthma receive an ICS-containing treatment, preferably as-needed ICS-formoterol for mild asthma.
What is maintenance-and-reliever therapy (MART)?
One ICS-formoterol inhaler used every day as maintenance and also as needed for symptoms. GINA recommends it from Step 3 because it lowers severe exacerbations compared with a fixed-dose ICS plus SABA reliever.
When is the next GINA report?
GINA updates its strategy report every year, usually in May.
Sources
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2026 update. ginasthma.org/reports
Summarized in our own words by 2 Minute Medicine's physician editors from the source documents listed here. Strength and evidence grades are the guideline authors' own. This is a quick reference, not a substitute for the full guideline or for clinical judgment.
For health care professionals. 2 Minute Medicine is independent and is not affiliated with or endorsed by the societies that write these guidelines.
Get the app