NICE has today published a single new guideline on the diagnosis and monitoring of asthma...

NICE has today published a single new guideline on the diagnosis and monitoring of asthma, and management of chronic asthma. 

Ever since NICE made known the intention to produce its own asthma guidelines, PCRS UK has argued strongly for a single consistent comprehensive and regularly updated asthma guideline for the four nations of the UK. 

PCRS-UK is concerned that the new NICE guideline will create uncertainty for primary care clinicians, because in some areas they recommend a different approach to the BTS/SIGN (British Thoracic Society and Scottish Intercollegiate Guidelines Network) guideline, which has set the evidence based standard for the UK since 2003. We do however recognise the importance of NICE’s incorporation of cost-effectiveness analysis, which is not addressed by BTS/SIGN.

PCRS-UK believes there is a risk that that multiple guidelines will confuse clinicians about the most appropriate approach to asthma diagnosis and management and notes that there are important areas of asthma care – such as the management of acute severe asthma– which are not covered by the NICE guideline.

Until the problem of multiple UK guidelines is rectified, PCRS-UK will have an important role to play in helping primary care professionals decide on the best course of action in the face of differing advice.

So PCRS-UK has produced guidance for primary care based on an assessment of and taking account of the guidelines from BTS/SIGN and NICE. The briefing paper comments on the differences between the BTS/SIGN asthma guideline and the new NICE asthma guideline and makes recommendations about the most practical approach for primary care.

In particular, the paper gives a detailed analysis of the two main areas where the NICE guideline recommends a different approach to established practice:

• The role and sequencing of objective tests in asthma diagnosis, including FeNO (fractional exhaled nitric oxide) testing, spirometry and peak flow measurement
• The use of leukotriene receptor antagonists (LTRAs)

The paper is a consensus of the views of a panel of experienced PCRS-UK primary care respiratory clinicians.

Action points:

• Download the PCRS-UK briefing paper HERE
• Download the new NICE guideline HERE 
• Discuss the new guideline and the PCRS-UK briefing paper with all clinicians in your practice and decide which approach to diagnosing and managing asthma you will take
• Discuss the new guideline and PCRS-UK briefing paper with your local group.