asthma – respiratory – inhaler – online
Source: ©Julian Claxton
This iteration of the joint BTS/SIGN guideline on the management of asthma is an update on the previous version, released in 2014. It comes after a draft NICE guideline on asthma was delayed due to GP workload concerns.
Key points for GPs
The guideline suggests using spirometry as part of an assessment to evaluate the initial probability of asthma, in order to give a baseline to assess response to trial of treatment.
- BTS/SIGN still recommend using a trial of treatment to diagnose patients with a high probability of asthma, and have refrained from following the path of draft NICE guidelines, which recommend conducting a series of objective tests instead.
- A LABA remains the first-choice add-on therapy if inhaled corticosteroids fail to control symptoms. This should be considered before increasing the dose of the corticosteroid. Previous guidance suggested a dose limit of 400µg BDP, but the update removes this.
- GPs can consider combined maintenance and reliever therapy in adults over the age of 18 who have a history of asthma attacks on medium-dose inhaled corticosteroids, or inhaled corticosteroids/LABA.
The delayed NICE guideline still promises to recommend a series of objective tests to diagnose asthma rather than a treatment trial, and would mean two conflicting guidelines for GPs to use to inform practice. NHS England’s intention to require GPs to be certified to perform spirometry by 2021 may also be a consideration (see page 16).
Dr Noel Baxter, a GP in south London and chair of the Primary Care Respiratory Society, said: ‘The BTS-SIGN guidance is absolutely welcomed because it supports current practice and provides very clear guidance on what can be a difficult diagnosis to make. The guideline is more pragmatic than NICE’s proposals, because it realises these tests need to be performed over time in the stable and non-stable state in order to accumulate evidence that this is asthma.’
BTS/SIGN. British guideline on the management of asthma. Edinburgh; SIGN: 2016