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GPs go forth

Quick guide: NICE's advice on asthma

Read a short summary of the new guideline

NICE published its first guideline on the diagnosis and management of asthma today. Here is a summary of the main recommendations.

  • GPs should not use symptoms without the results of objective tests to make a diagnosis of asthma.
  • Patients should be treated immediately if they present with acute symptoms and objective tests should be performed if the equipment is available.
  • CCGs should consider establishing asthma diagnostic hubs to improve the practicality of implementing the guideline.
  • Offer a FeNO test to adults aged 17 and over if an asthma diagnosis is being considered. - A level of 40 parts per billion or more is a positive test
  • Consider a FeNO test in children aged 5-16 years if there is diagnostic uncertainty after initial assessment and they have either normal spirometry or obstructive spirometry with a negative bronchodilator reversibility test. - A level of 35 parts per billion or more is a positive test
  • Offer spirometry to adults and children aged 5 and over if an asthma diagnosis is being considered. - A FEV1/FVC ratio of less than 70% is a positive test
  • Offer a bronchodilator reversibility test to adults with obstructive spirometry results and consider one in children with obstructive spirometry.
  • If an adult is unable to perform a particular objective test, try a least two other tests and base the diagnosis on symptoms and any positive test results.
  • Offer a short-acting beta agonist as a reliever treatment to adults with newly diagnosed asthma.
  • Offer a low dose of inhaled corticosteroid as the first-line maintenance treatment to adults.
  • If this does not control the asthma, offer an LTRA and review the response in four to eight weeks
  • If the asthma remains uncontrolled, add a LABA in combination with the inhaled corticosteroid
  • Monitor asthma control at every review and consider using a validated questionnaire to do this in adults.
  • Do not routinely use FeNO to monitor asthma control. 
  • Consider FeNO measurement as an option to support asthma management in patients whose asthma remains uncontrolled despite using inhaled corticosteroids. 

Source: NICE

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Readers' comments (1)

  • Great....another impractical NICE guidance...who has access to FeNo testing?!......will be loved by solicitors acting on behalf of their clinical negligence clients looking for the slightest deviation from the 'gold standard' to beat us over the head.

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