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.