BTS/SIGN updates asthma guidance

The British Thoracic Society (BTS)/SIGN guidelines on the management of asthma have been updated, with revisions made to the sections on pharmacological management, the management of acute asthma and asthma in pregnancy.

Until May 2009 all doses of inhaled steroids in the pharmacological management section have been referenced against beclometasone (BDP) given via metered dose inhalers using a CFC-propellant.

As BDP-CFC is phased out, the reference inhaled steroid will be the BDP-HFA equivalent, which can be used at the same dosage. Adjustments to doses will have to be made for other devices and other corticosteroid molecules.

The guidelines include a table of equivalent doses of inhaled steroids relative to CFC-BDP, see below.

The updated pharmacological management section also states that while the use of inhaled corticosteroids may be associated with adverse effects, including the potential to reduce bone mineral density, with careful inhaled steroid dose adjustment this risk is likely to be outweighed by their ability to reduce the need for multiple bursts of oral corticosteroids.

The revised management section now advises that all asthma patients should be asked by their GP about past reactions to beta-blockers and NSAIDs, following a number of reported deaths.

Additional information has been added on the use of oxygen therapy. The guidance recommends that supplementary oxygen should be given urgently to hypoxaemic patients, using a face mask, Venturi mask or nasal cannulae. Oxygen saturation monitors should be available for use by all health professionals assessing acute asthma in both primary and secondary care settings.

Evidence has been added to the asthma in pregnancy section, with the guidance calling for GPs to monitor pregnant women with moderate/severe asthma closely to keep their asthma well controlled. Women should also be advised of the importance of maintaining good control of their asthma during pregnancy to avoid problems for both mother and baby.

Update searches were conducted on inhaler devices but there was insufficient new evidence to change the existing recommendations.

The full guideline is available at www.brit-thoracic.org.uk

BTS and SIGN – Equivalent doses of inhaled steroids relative to BDP
These dosage equivalents are approximate and will depend on other factors such as inhaler technique.
UK licence covers
STEROIDEQUIVALENT DOSE>12 YEARS5–12 YEARS<5 YEARS
Beclometasone dipropionate CFC400 microgramsNo longer available
BECLOMETASONE
Clenil modulite400 microgramsyesyesyes
ClickhaleryesOver age 6no
Aerobec Autohaleryesnono
Asmabec ClickhaleryesOver age 6no
Dry powder (Becodisks)yesyesyes
Easyhaleryesnono
PulvinalyesOver age 6no
Filairyesyesyes
Qvar200 to 300 microgramsyesnono
Fostair200 microgramsOver age 18nono
BUDESONIDE
Turbohaler400 microgramsyesyesno
Metered dose inhaleryesyesOver age 2
EasyhaleryesOver age 6no
NovolizeryesOver age 6no
SymbicortyesOver age 6no
Symbicort (regular and as required dosing)Over age 18nono
FLUTICASONE
Metered dose inhaler (HFA)200 microgramsyesyesOver age 4
AccuhaleryesyesOver age 4
Seretide HFAyesyesOver age 4
Seretide (Accuhaler)yesyesOver age 4
MOMETASONE200 microgramsyesnono
CICLESONIDE200 to 300 microgramsyesnono
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