NICE changes advice on inhaled corticosteroid doses in children with asthma
NICE has produced final guidance overturning a previous recommendation on increasing inhaled corticosteroid doses in children and young people with uncontrolled asthma.
The partial update comes after experts found a lack of evidence to support encouraging children and young adults to up their ICS dose if they were having exacerbations.
It replaces a 2017 recommendation to consider a quadrupling of the regular ICS dose in children who are experiencing an exacerbation.
The new guidance says there is limited evidence of clinical benefit from increasing the dose as the original evidence was based on extrapolation from adult data and one study in children and young people that was of very low quality.
Further studies had since been published that showed increased ICS doses for exacerbations in children and young people, aged 5 to 16 years, demonstrated no benefit in regaining control, experts had warned.
The updated recommendation emphasizes the importance of regular use of ICS in children and young people with deteriorating asthma to help regain control of their symptoms, rather than increasing their dose.
In addition, self-management plans for children and young people should now advise them to contact a healthcare professional for a review if their asthma control deteriorates.
A proposed updated had been put out for consultation at the end of last year.
A study published in 2018 found that temporarily quadrupling the dose of ICS during an exacerbation could help to prevent a severe asthma attack, but this included mostly adults and the magnitude of risk reduction was smaller than expected.
In 2019, NICE announced that it would collaborate with BTS/SIGN to produce a single set of asthma guidance to alleviate confusion for GPs.
Pharmacological treatment for five-to-16-year-olds with asthma
1.10.3 For children and young people aged 5 to 16 with a diagnosis of asthma, include advice in their self-management programme on contacting a healthcare professional for a review if their asthma control deteriorates. 
1.10.4 For children and young people aged 5 to 16 with deteriorating asthma who have not been taking their ICS consistently, explain that restarting regular use may help them to regain control of their asthma. The evidence for increasing ICS doses to self-manage deteriorating asthma control is limited.