The 2025 edition of the Spanish Asthma Guidelines (GEMA 5.5) presents significant advancements in asthma diagnosis and management. This editorial outline the principal modifications, such as the identification of novel risk factors, a therapeutic emphasis on achieving clinical remission, and enhanced approaches to pediatric care and comorbidity management. The updated guideline also integrates biologic therapies and revised treatment algorithms, underscoring GEMA's dedication to evidence-based, precision medicine in asthma care.1
Rather than serving as an exhaustive compendium of asthma research, GEMA is structured as a succinct, practical resource that distills essential clinical knowledge for optimal patient management. It is tailored to assist both generalists and specialists in making informed clinical decisions and is freely available in various formats to maximize accessibility and clinical utility.
A distinguishing feature of GEMA is its annual update process, overseen by the Executive Committee and supported by the independent Pro-GEMA Commission, which consists of four external experts. These reviewers systematically appraise and select the most pertinent asthma research published in indexed journals over the preceding year, forming the evidentiary basis for each new edition. With the release of version 5.5, GEMA enters its fifth phase of development.
From an epidemiological perspective, GEMA 5.5 formally recognizes very low birth weight (<1500g) as a new risk factor for asthma, highlighting the importance of neonatal screening for respiratory vulnerability.2 Additionally, the guideline establishes clinical remission – defined as the absence of symptoms and exacerbations, stable and normal lung function, and no systemic corticosteroid use for at least one year – as the primary therapeutic objective.1,3
This edition also re-evaluates the use of biologic therapies in emergency settings, particularly during severe asthma exacerbations, guided by emerging evidence.4 The section on uncontrolled severe asthma features an updated, phenotype-driven therapeutic algorithm, enhancing the selection of biologics and improving patient outcomes.1
New data support the MART (Maintenance and Reliever Therapy) approach for individuals over 12 years,5 and recommendations regarding salbutamol use in younger children have been clarified.6 For pediatric patients with severe asthma, indications for biologic therapies are now summarized in a new table to facilitate phenotype-based clinical decisions, promoting the early and effective use of agents such as omalizumab, mepolizumab, benralizumab, dupilumab, and Tezepelumab.1,7
GEMA 5.5 also incorporates recent findings on chronic rhinosinusitis, both with and without nasal polyps, and highlights the efficacy of new biologic treatments for these conditions.8–11 The chapter on allergic bronchopulmonary aspergillosis (ABPA) has been updated in line with the ISHAM-ABPA 2024 consensus, including revised diagnostic criteria, classification, and management strategies.12 For eosinophilic granulomatosis with polyangiitis (EGPA), benralizumab is now recognized as a validated therapeutic option to reduce corticosteroid dependence and recurrence.13,14
Overall, GEMA 5.5 marks a transition from control-based to remission-focused asthma management, integrates recommendations for both pediatric and adult populations, and embraces advances in biologic therapies. Its rigorously updated, evidence-based content provides healthcare professionals across specialties with a reliable framework for asthma care.
FundingNone declared.
Authors’ contributionsCA and VP: designed contents and wrote the manuscript draft.
MB, JF, GG, AM, SQ, and GSC: revised, corrected and approved the final manuscript.
Declaration of generative AI and AI-assisted technologies in the writing processAI has been used to improve English writing.
Conflicts of interestCA in the last three years received honoraria for speaking at sponsored meetings from AstraZeneca, Boehringer-Ingelheim, Chiesi, Gebro, GSK, and Sanofi. Act as a consultant for AstraZeneca, Chiesi, GSK and Sanofi.
MB in the last three years received honoraria for advisory and speaking at sponsored meetings from AstraZeneca, GSK, TEVA, Sanofi, Chiesi.
JF in the last three years received honoraria for speaking at sponsored meetings from AstraZeneca, Bial, GSK, Sanofi, MSD, Tecnimed, Tecnifar, Medinfar and Inmunotek. Received help assistance to meeting travel from AstraZeneca, Bial, GSK, Sanofi, Tecnimed, Tecnifar, Medinfar and Inmunotek.
GG in the last three years received honoraria for speaking at sponsored meetings from Chiesi, GSK, Novartis and Sanofi. Received help assistance to meeting travel from GSK and Sanofi. Act as a consultant for GSK and Sanofi and received honoraria for investigation clinical trials from GSK, Sanofi, Chiesi, WorldWide, PPD, Insmed, Fortrea, Areteia and AZ.
AM in the last three years received honoraria for speaking at sponsored meetings from AstraZeneca, Bial, GSK, Leti, Medinfar, TEVA, Takeda and Viatris.
SQ has been on advisory boards for and has received speaker's honoraria from Allergy Therapeutics, AstraZeneca, Chiesi, GlaxoSmithKline, Gebro, Novartis and Sanofi.
GSC in the last three years received honoraria for speaking at sponsored meetings from AstraZeneca, Menarini, Aflorfam, Gebro, GSK and Sanofi. Received help assistance to meeting travel from AstraZeneca and Sanofi. Act as a consultant for AstraZeneca and Sanofi.
VP in the last three years received honoraria for speaking at sponsored meetings from AstraZeneca, Boehringer-Ingelheim, Chiesi, Gebro, GSK, Luminova-Medwell and Sanofi. Received help assistance to meeting travel from AstraZeneca and Chiesi. Act as a consultant for AstraZeneca, Chiesi, GSK and Menarini.
