Posted by: Tony Copperfield28 January 2015
It’s been some time since I’ve had a pop at NICE, though it hasn’t been for a lack of opportunity. But these latest draft guidelines on asthma are so outlandish that they have me coughing and spluttering myself towards status asthmaticus, assuming I really do have asthma – and, according to NICE, there’s about a one in three chance that I don’t, in which case it’s panic-induced hyperventilation, then.
Look, if you want to feel the real force of this polyinvestogram-fest heading your way, then read the whole damn thing yourself, like I just have. But to give you a potted highlight, the way we will diagnose asthma in every case in future will involve (and here I’d take a deep breath if only I could) spirometry with reversibility testing, then a Fractional Exhaled Nitrous Oxide test (no, me neither), then, depending on the results, peak flow variability monitoring for four weeks, and depending on the results of that, a histamine/methacholine challenge.
Simples, as I believe the young people say – oh, and by the way, it includes them. Apparently anyone over the age of five can cope with most of that little lot, providing, I guess, they don’t have other distractions, such as school, eating etc.
Look, as we all know, the best guidance is that which reflects what we do already, and SIGN should be congratulated here because its asthma guidance of last year allows for clinical judgement and trials of treatment. Guidance which reinforces our current approach is either an affirmation that we’ve been right all along or a collusion in poor care. In terms of asthma, NICE obviously thinks the latter. And presumably it would defend its approach through the alleged high rates of misdiagnosis.
Fine, but if there is a problem, this punishment is worse – in terms of cost, inconvenience to patients and grinding us GPs into the ground – than the crime. The signs were there with the recent draft cancer referral guidelines which will flood secondary care for the sake of a marginal improvement in the stats.
Conclusion? I’ve never been convinced that NICE was in possession of a plot. But if it was, it’s lost it.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.