Primary-Care-Forward Asthma Management: Evolving Reliever Paradigms and Stewardship from the 2019 Landmark to GINA 2024–2026

The Global Initiative for Asthma (GINA) strategy reports have undergone critical updates between 2024 and 2026, marking a complete transition from symptom-based bronchodilator rescue to proactive, anti-inflammatory-driven asthma control [1-3]. This report provides a comparative clinical analysis of the GINA 2024, GINA 2025, and GINA 2026 updates, detailing the structural evolution of treatment tracks, advancements in diagnostic criteria, and the integration of novel therapeutics [4-6]. While GINA 2024 established the preferred Track 1 (ICS-formoterol) and alternative Track 2 (SABA reliever) frameworks to mitigate SABA overuse [1]. GINA 2025 integrated Type 2 biomarkers (FeNO and blood eosinophils) and age-specific diagnostic pathways for pediatric populations aged 5 years and under [2, 7-9]. GINA 2026 represents a landmark primary-care-forward update, dismantling SABA monotherapy at Step 1 of Track 2 by introducing combination ICS-SABA as an alternative anti-inflammatory reliever (AIR) [3]. Additionally, GINA 2026 elevates oral corticosteroid (OCS) stewardship as a formal priority, mandates device consistency, and incorporates the twice-yearly anti-IL-5 biologic depemokimab for severe eosinophilic asthma [3, 6, 10, 11]. This systematic analysis serves as an essential resource for clinicians navigating these evolving therapeutic paradigms to optimize patient-centered asthma care globally