Case Series

Evolution of Pediatric Asthma Management Across GINA 2024–2026: A Case Series Illustrating Changes in Diagnosis, Step Therapy, and Severe Asthma Care

Abstract

Background: Recent updates to the Global Initiative for Asthma (GINA) strategy reports (2024–2026) reinforce anti inflammatory reliever therapy, corticosteroid stewardship, and biomarker guided management in pediatric asthma. However, practical clinical translation of these evolving recommendations remains underreported. Methods: We present a case series of four pediatric patients representing distinct asthma severity phenotypes (preschool wheeze, mild asthma with exacerbation risk, moderate persistent asthma, and severe Type 2–high asthma). Each case was retrospectively analyzed against recommendations from GINA 2024, 2025, and 2026 to illustrate changes in therapeutic decision making. Results: Across cases, progressive strengthening of anti inflammatory reliever therapy (Track 1, ICS–formoterol) was evident. Pediatric randomized controlled trial evidence supports maintenance and reliever therapy (MART) in children 6 years, demonstrating reduced severe exacerbations without increased corticosteroid exposure. Successive GINA updates increasingly emphasized systemic corticosteroid minimization, structured severe asthma evaluation, biomarker integration (eosinophils, FeNO), and global access to ICS containing inhalers. Clinical decisions shifted from symptom based escalation toward risk based and phenotype driven management. Conclusion: The transition from GINA 2024 to 2026 reflects maturation of an inflammation first, precision based pediatric asthma strategy. Implementation of anti inflammatory reliever therapy and corticosteroid stewardship may meaningfully reduce exacerbation burden and systemic steroid exposure in children. These cases demonstrate how incremental guideline refinements translate into measurable clinical impact. 

Authors affiliation:

Khurshed Alam Choudhury (ORCID): Department of Pediatrics, United Institute of Medical Sciences,Prayagraj, Uttar Pradesh, India.
Kanak Lata Yadav (ORCID): Department of Pediatrics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

How to Cite: K. A. Choudhury and K. L. Yadav. Evolution of Pediatric Asthma Management Across GINA5 2024–2026: A Case Series Illustrating Changes in Diagnosis, Step Therapy, and Severe Asthma Care. Journal of Applied Health Sciences and Medicine, 6(7):17–22, 2026. https://doi.org/10.58614/jahsm672