The edition · Pulmonology
GINA 2026 keeps SABA-only treatment off the table, and dupilumab's lung-function gains in type 2 COPD
The 2026 GINA summary again recommends ICS-containing treatment for everyone with asthma and prefers as-needed ICS-formoterol as reliever. Pooled BOREAS and NOTUS data show dupilumab raised FEV1 by about 80 mL in COPD with type 2 inflammation.
The edition in brief
The 2026 GINA strategy report summary recommends ICS-containing treatment for all adults, adolescents, children and most preschoolers with asthma, advises against SABA-only treatment, and prefers low-dose ICS-formoterol as an anti-inflammatory reliever, either as needed or as maintenance-and-reliever therapy; 2026 changes expand reliever options, revise biologic selection and update acute management. A post hoc analysis of BOREAS and NOTUS (1,874 patients with COPD and type 2 inflammation) found dupilumab improved pre-bronchodilator FEV1 by 83 mL over placebo, with gains seen early and sustained to a year and larger at higher eosinophil counts or FeNO. A meta-analysis of nine small trials found airway pressure release ventilation improved oxygenation but showed no mortality benefit in ARDS (RR 0.95), with low certainty. Twelve observational studies linked household second-hand smoke with higher odds of TB infection or disease in children (OR about 2.7). The pearl: check inhaler technique before stepping up.
Dupilumab raised FEV1 by about 80 mL in COPD with type 2 inflammation
In COPD with type 2 inflammation, dupilumab gives modest, sustained lung-function gains alongside fewer exacerbations; select by eosinophil count.
Airway pressure release ventilation improved oxygenation but not survival in ARDS
In ARDS, APRV raises oxygenation but has not been shown to improve survival; keep lung-protective conventional ventilation as standard.
Household second-hand smoke was linked to higher odds of TB in children
Ask about household smoking when assessing children for TB risk, and support cessation for family members.
Watch the inhaler being used before stepping up treatment
Check and correct inhaler technique and adherence before stepping up asthma or COPD treatment.
GINA 2026: no SABA-only treatment, and ICS-formoterol as the preferred reliever
Move every asthma patient off SABA-only treatment onto ICS-containing therapy; for adults and adolescents, ICS-formoterol as reliever is preferred.
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