BTS response to new NICE asthma guidelines

The British Thoracic Society (BTS) has published a practical response to two new asthma guidelines from NICE - to help all clinicians and people with asthma, and their carers, to make informed decisions about their care.  It is available here via the Thorax website. 

The response highlights the differences and similarities between the BTS/ SIGN and the new NICE asthma guidelines. This follows BTS feedback to NICE as part of the consultation on their new asthma guidelines. 

The main differences arise from slightly differing scope and method.

The BTS/ SIGN Asthma Guideline is more wide-ranging than the NICE guidance – it covers the diagnosis, treatment and management of asthma in children and adults.  The new NICE asthma guidelines cover key areas of asthma diagnosis and chronic management, but do not include guidance on the management of acute asthma attacks in both adults and children, or severe or difficult asthma.

BTS/ SIGN’s Asthma Guideline reviews clinical effectiveness and practical implementation studies to underpin its recommendations.  NICE’s methodology includes a cost benefit analysis. 

The BTS/ SIGN Asthma Guideline, first produced in 2003, offers the latest, evidence-based clinical guidance for the diagnosis, treatment and management of asthma in children and adults.  It has been called the ‘gold standard’ of asthma management, with updates published regularly.  The latest BTS/ SIGN Asthma Guideline for the management of asthma was published in 2016 - the next is scheduled for 2019.

Dr Lisa Davies, respiratory consultant and Chair of the BTS Board of Trustees, commented:

“Our priority has always been for clinicians caring for people with asthma to have access to the latest, evidence-based clinical guidance for the diagnosis, treatment and management of asthma – through our comprehensive BTS/ SIGN Asthma Guideline. 

“We urge everyone working in the field of asthma to read our response to NICE’s new asthma guidelines.  We hope this will help clinicians make informed decisions about the care they provide. 

“We welcome the fact that the new guidance from NICE underlines some important themes within BTS/ SIGN Asthma Guidance, including the key role of quality-assured spirometry to help diagnose asthma accurately in many patients.

We are, however, concerned about a number of areas, including the recommendation that people whose asthma is proving insufficiently controlled, are prescribed LTRA as a next step in addition to their preventer medication (inhaled corticosteroids).  We feel that this recommendation may make treatment more complex and costly for the patient, and could lead to possible unintended health effects – such as flare-ups of their condition. 

Alongside many other specialist organisations, we have offered NICE our feedback throughout the consultation process, and will meet them again shortly to discuss next steps for the benefit of patients and clinicians.”

December 2017