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Patients ‘in limbo’ due to ambiguity of asthma guidelines, says report

The new joint guidelines from NICE and BTS/SIGN need to clear up ambiguity around asthma treatment, as patients remain ‘in limbo’ due to lack of clarity, a report has said.

It comes after the British Thoracic Society and SIGN said they would produce a joint guideline with NICE to alleviate ‘confusion’ for GPs.

The report, by Asthma UK, said that the current differing guidance has created ‘variable care’ across the UK. It found that only 18% of people who, according to clinical guidelines, should be referred to a specialist, are referred.

It also found that three quarters of those on three or more courses of oral corticosteroids had not had an appointment with an asthma specialist.

Asthma UK said clearer referral guidelines and a consistently applied care pathway were needed to improve this, including using data to identify people at risk as well as increasing capacity in secondary care.

The report, called Living in Limbo: the scale of unmet need in difficult and severe asthma, said: ‘Currently, there are no statutory guidelines on the management of people with difficult and severe asthma which has contributed to the variable care received.

‘The guidelines that do exist say GPs should refer people with asthma to specialist care if they are taking high-dose inhaled steroids. Our new analysis shows that for around 160,000 people in the UK this is not happening.’

It added: ‘Three-quarters of people who are taking three or more courses of oral steroids per year – in other words, suffering serious, life threatening asthma attacks every four months – are not getting referred for a specialist medical opinion as they should be.

‘We welcome the recent announcement that NICE and BTS will work together to develop guidelines for the asthma pathway. The challenge is for new referral criteria to deliver improvements in care, and address the unmet need highlighted in this report.’

A spokesperson from NICE said: ‘When treating uncontrolled asthma in adults, young people and children under five, NICE guidance recommends seeking advice from a healthcare professional with expertise in the field. We are also currently working with partners at the British Thoracic Society (BTS) and Scottish Intercollegiate Guideline Network (SIGN) to produce UK-wide guidance for the diagnosis and management of chronic asthma in adults, young people and children.

‘This will help healthcare professionals to make accurate diagnoses and provide effective treatments. NICE produces guidelines that reflect the best, most up-to-date evidence and we believe people have the right to be involved in discussions about their care in order to make informed decisions about their treatment.’

It follows the news that asthma deaths have reached their highest level in a decade