Updated British guideline on the management of asthma
The updated British Asthma Guideline has been published today on British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) websites. This update has focused on the chapters on diagnosis and pharmacological therapy. Download the guide HERE
The updated British Asthma Guideline has been published today on British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) websites. This update has focused on the chapters on diagnosis and pharmacological therapy.
The updated Diagnosis chapter continues to reinforce the importance of proceeding towards a diagnosis based on the probability of asthma, and that asthma is a variable condition for which there is no definitive diagnostic test. It suggests that objective testing can be useful, but should take place in the context of a ‘structured clinical assessment’. The chapter considers adults and children together, and is based on the same evidence base as the NICE guideline on diagnosis and monitoring, which is not due for publication until next year.
In the Pharmacology chapter, there are some significant changes to the presentation of the familiar steps of asthma management, and to comparing inhaled corticosteroid (ICS) strengths. A phased approach to treatment is still recommended but the numbering of the steps has been replaced by more helpful descriptions. It recommends that anyone prescribed more than one short acting bronchodilator (SABA) inhaler device a month should be identified and have their asthma assessed urgently. Former step 3 has now been divided into two. The rationale for moving away from numbered steps is to avoid confusion since the content of former steps 1-3 has changed significantly. Comparing other ICS with BDP has not been helpful since CFC-free inhalers were introduced, so the new banding of ICS by strength should be more accurate and more straightforward in practice.
Dr Noel Baxter, GP, Commissioner in Southwark and Chair of PCRS-UK Executive Committee, said: ‘The guideline group has worked hard to ensure that this guideline reflects the reality of primary care, and is practical to implement in general practice. We urge you to look at these chapters to become familiar with the changes.’
Carol Stonham, Nurse Lead for PCRS-UK, a nurse practitioner at Minchinhampton Surgery Stroud and a Queen’s Nurse, says: ‘This guideline update broadly reinforces the content of previous guidelines on diagnosis and pharmacological treatment. It recognises that there is no definitive diagnostic test for asthma and therefore diagnosis needs to consider a lot of different factors and needs to take place over time considering relevant tests that would confirm the diagnosis. The stepwise approach to treatment has been preserved but the numbered steps have been replaced with verbal descriptions, since the primary role of preventive treatments have been emphasised and clarified.’
Click HERE for a link to a more detailed PCRS-UK guide to the updated British Asthma Guideline for primary care
Click HERE to link to the updated National asthma guideline
Click HERE to link to the Current Asthma Quick Guide. PCRS-UK will be updating its Asthma Quick Guide to reflect these changes in the next couple of months, so look out for the updated version.
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