Global Initiative for Asthma Updates for Diagnosing Asthma in Adults

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The GINA 2023 report had perfect specificity (100%) but poor sensitivity (47%) for asthma diagnosis due to the inclusion of airflow limitation (AFL).
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The removal of AFL in the GINA 2024 update increased asthma diagnoses from 27% to 63%, improving sensitivity but reducing specificity.
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The addition of type 2 inflammatory biomarkers in GINA 2025 improved sensitivity to 67% but decreased specificity to 96%.
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Introducing fractional exhaled nitric oxide and blood eosinophil counts as biomarkers may enhance cost-effectiveness in asthma diagnosis.
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The GINA pathway has shifted from a 'rule-in' to a 'rule-out' approach, increasing the risk of overdiagnosis while minimizing missed cases.

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