Marking the anniversary of the BTS/NICE/SIGN Joint Guideline on Asthma: Diagnosis, Monitoring and Chronic Asthma Management

Asthma is a common lung disease that affects around eight in every 100 people, with around 5.4 million people experiencing breathlessness, wheezing, and tightness in the chest due to this long-term condition.

As part of developing the Guideline, the independent committee looked at a huge body of research. This represented a key opportunity to create guidance that would benefit patients and save lives. Having one clear set of national asthma guidelines means that people can receive consistent and effective asthma diagnosis, treatment and care throughout the UK.

Among the many recommendations, the Guideline recommended that healthcare professionals should:

• Diagnose asthma using simple tests when people first show symptoms.
• Move away from prescribing the familiar ‘blue ‘reliever-only inhaler when asthma is first diagnosed, and instead, always prescribe maintenance or combination treatments which prevent and relieve symptoms.
• Offer a low-dose combination of inhaled corticosteroids (ICS) and formoterol to be taken as needed by everyone aged 12 and over with newly diagnosed asthma. This will help to relieve symptoms and reduce inflammation.
• Stop prescribing short-acting beta2 agonists (SABA), the most widely used blue ‘reliever’ medication, without ICS, to anyone diagnosed with asthma.

As part of the guideline publication, BTS, NICE, and SIGN have also developed an accompanying digital asthma pathway. This online hub features existing BTS/SIGN guidance on management of acute asthma, non-pharmacological management, and occupational asthma. Other resources include a joint patient decision aid on asthma inhalers and climate change, as well as all asthma medicines and treatments recommended by NICE, and advice from the Scottish Medicines Consortium. The Asthma Pathway is accessible from each organisation’s website.

It is hoped that a move away from the use of SABA inhalers will help protect patients from the harms of overuse, which have been linked to higher risks of severe attacks. The reduction in SABA use will also be beneficial to the environment, as this will lead to a shift away from propellant inhalers to low-carbon alternatives.

Professor Richard Russell, Chair of the BTS Board of Trustees, said:

“This joint guideline is a radical shift in the way we approach and manage the majority of patients with asthma. It has energised all who treat patients with asthma with education and implementation initiatives being launched across the UK. This is not a short-term blip in interest but will result in a fundamental change to diagnosis and treatment for the most common chronic respiratory disease in our country. This is an opportunity that, if supported with the focused provision of resource, will result in urgently needed improvements in outcomes for our patients.”

Professor Jonathan Benger, chief medical officer and interim director of the Centre for Guidelines at NICE, said:

“I am delighted BTS, NICE and SIGN collaborated to develop this useful and useable guideline. It aims to help ease the pressure on the health service by reducing hospital admissions due to asthma and lowering the use of less effective monitoring tests.

Having one clear set of national asthma guidelines is vital to ensure people receive consistent and effective asthma care across the health service, so people across the UK receive the right diagnosis and treatment for them.”

Professor Angela Timoney, Chair of SIGN Council, said:

"I am delighted that this collaborative guideline has been so well received across the UK, particularly as I know that in Primary Care, many staff across a range of disciplines have been working hard to implement the recommendations with their patients. This will improve the lives of those with asthma and their families.

The guideline has been welcomed both in the UK and internationally, with healthcare professionals committed to its implementation throughout the health service. As the rollout of the Guideline continues, it is crucial that NHS professionals are skilled in the treatment of asthma care, including the delivery of simple diagnostic testing.

Notes

The BTS/NICE/SIGN Joint Guideline on Asthma: diagnosis, monitoring and chronic asthma management

The joint Guideline can be accessed on the NICE website. In Scotland, the Guideline is available on the SIGN website and accompanied by patient guides for adults, children and young people, and pregnancy.

The Joint Asthma Pathway

The pathway can be linked via Health Improvement Scotland's Right Decision Service here, or via the NICE website here.

Update to the Guideline

BTS, NICE and SIGN have updated recommendation 1.8.2 in the collaborative Asthma guideline after a budesonide/formoterol dry powder inhaler (100 micrograms/6 micrograms per inhalation) was licensed for MART in children aged 6 to 11.

The accompanying visual summary and ICS dose guide have also been updated and can be found here: Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN).