BTS/NICE/SIGN Asthma Guidelines

A new guideline published today (Wednesday, 27 November) recommends chronic asthma should be diagnosed by healthcare professionals when people first show symptoms by using simple tests.

The guideline also says healthcare professionals should always prescribe maintenance or combination treatments, which prevent and relieve symptoms, rather than the familiar blue ‘reliever-only’ inhaler, when asthma is first diagnosed.

For the first time, the British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) have worked together to produce a new UK-wide joint guidance for the diagnosis and management of chronic asthma in adults, young people and children.

It recommends healthcare practitioners should offer a low-dose combination of inhaled corticosteroids (ICS) and formoterol to be taken as needed for everyone aged 12 and over with newly diagnosed asthma to reduce inflammation as well as relieve symptoms.

It recommends not prescribing short-acting beta2 agonists (SABA), the most widely used blue ‘reliever’ inhaler/medication, without inhaled corticosteroids, to anyone diagnosed with asthma.

The independent guideline committee looked at evidence which showed using the combined ICS and formoterol inhalers when required led to people suffering fewer severe asthma attacks.

As part of the final guideline publication BTS, NICE and SIGN have also developed a new digital resource which will act as a ‘one stop shop’ online. The digital asthma pathway links to tools, resources and information, all stored in a central hub, accessible from each organisation’s website.

The pathway has been designed to support health professionals in making accurate diagnoses, promoting good practice, and providing effective, personalised treatment to control and prevent acute asthma attacks.

The asthma pathway includes existing BTS/SIGN guidance on management of acute asthma, non-pharmacological management, and occupational asthma. Other resources include a joint patient decision aid on asthma inhalers and climate change, all asthma drugs and treatments recommended by NICE and advice from the Scottish Medicines Consortium.

Asthma is a common lung condition, where people have breathing difficulties. Symptoms include breathlessness, coughing, wheezing and tightness in the chest. In the UK, around 5.4 million people have asthma, which is about eight in every 100 people.

Dr Paul Walker, BTS Chair, said: "The British Thoracic Society and respiratory professionals welcome the new asthma guideline and the impact it will have on asthma care across the whole United Kingdom. The change in diagnostic investigations will simplify diagnostic processes and help with current diagnostic delays for adults, children and young people. The treatment changes represent a true pivot in the principles of asthma care and will contribute to improved outcomes. The society wishes to thank the very many people who have worked to deliver this guideline. This is only the start of much hard work in dissemination, education and implementation but this will ultimately deliver better care for people with asthma."

Professor Jonathan Benger, chief medical officer and interim director of the Centre for Guidelines at NICE, said: “I am delighted we have collaborated with BTS and SIGN to develop this useful and useable guideline. It aims to help ease the pressure on the health service by reducing hospital admissions due to asthma and lowering the use of less effective monitoring tests."

“Having one clear set of national asthma guidelines is vital to ensure people receive consistent and effective asthma care across the health service, so people across the UK receive the right diagnosis and treatment for them.”

"The guideline also includes new recommendations for the diagnosis of asthma in both adults and children, including the use of FeNO (a simple breath test) and measurement of eosinophil cells in the blood as well as traditional tests like spirometry or peak flow measurements."

Professor Angela Timoney, chair of the SIGN Council, said: “I am very pleased for clinicians and patients across the UK that our three organisations have worked together to produce a guideline that will impact on diagnosis and treatment of patients with asthma. The recommendations are based on rigorous appraisal of the evidence and will change and improve asthma care."

You can read the full asthma: diagnosis, monitoring and chronic asthma management guideline on the NICE website.