Dr Dermot Ryan 330x330px
It is really important that patients with asthma receive a proper diagnosis but the overconcentration on one parameter – in this case FeNO – is neither here nor there. Most GPs don’t have access to FeNO and most CCGs don’t have the funds or the know-how to invest in it.
Furthermore, many adults with asthma don’t have a phenotype that leads to elevated FeNO results, so a negative FeNO doesn’t mean they haven’t got asthma. I think the guideline is setting GPs up for failure because there isn’t access to these resources.
The recommendation to add an LTRA to inhaled corticosteroid therapy is foolish on many levels – European colleagues will be laughing and the Scots to whom this doesn’t apply will look down their noses in scorn at this outlandish proposal. In the best trials, there are only a few people who respond well to LTRAs.
For the rest though, they’re coming back 4-8 weeks after being given the LTRA, which is time during which they have symptoms, they may have an exacerbation, the surgery has to provide another appointment and the patient is following a confusing mixed regimen.
This is being done purely for cost minimisation – for an organisation that purports to uphold clinical excellence, this is not clinical excellence. This should be resisted and it won’t save money. It’s not for no reason that guidelines elsewhere in the world recommend a LABA as the first add-on to inhaled corticosteroid.
Really this guideline is not fit for purpose.
Dr Dermot Ryan is president of the Respiratory Effectiveness Group and a GP in Loughborough