There are many diseases and conditions for which care is shared across primary, secondary, and tertiary healthcare providers, sometimes through formal shared-care arrangements or via ad-hoc referral of patients as and when needed. In these instances, communication and collaboration are paramount to achieving the best outcomes for patients. This need is recognised in many new and updated guidelines, which now include recommendations about shared-care protocols, when and where to refer, and the overall care pathway as patients move between care providers. The articles in this issue of Guidelines in Practice touch on shared care as a common theme.

The 2019 update to the Global Initiative for Asthma (GINA) strategy document brought fundamental changes to the recommendations about asthma treatment. Short‑acting beta2-agonist (SABA)-only treatment is no longer recommended by GINA for treatment of asthma in adults and adolescents. GINA now recommends that these patients should receive either symptom‑driven or daily inhaled corticosteroid (ICS)‑containing controller treatment. This change is based on strong evidence that SABA‑only treatment increases the risk of severe exacerbations and asthma‑related death, and that adding any ICS significantly reduces the risk.

GINA 2019 has also recommended earlier referral of patients for specialist assessment because there are new biological treatments available for people with severe asthma that can only be accessed through specialist care. Dr Mark L Levy provides his personal view on these new recommendations from GINA and shares tips on what to advise patients who wish to continue using their SABA.

To learn more about shared care and the guidelines discussed in this issue, come to Guidelines Live 2019—for more information and to see what will be covered, visit