BTS/SIGN updates guidance on the management of asthma

Following a major review, the British Thoracic Society and Scottish Intercollegiate Guidelines Network have re-published their joint guidance on the management of asthma.

While the stepwise approach to management remains unchanged, the section on diagnosis has been re-written and new advice is provided on topics including difficult asthma.

SUMMARY OF KEY CHANGES

Diagnosis

  • In adults, spirometry is considered the preferred initial test to assess airflow obstruction.
  • Clinical features that influence the probability of asthma are listed for adults and children.
  • Patients with a high probability of asthma should be offered a trial of treatment; those with a low probability require further investigation of more likely alternative diagnoses or specialist referral.
  • In patients with an intermediate probability, management may include an explicit trial of treatments for a specified period, watchful waiting (in children) or further investigations, including reversibility tests or assessment of airway responsiveness.

Pharmacological management

  • The aim of management is to control the disease (defined as no daytime symptoms, no night time awakening due to asthma, no need for rescue medication, no exacerbations, no limitations on activity and normal lung function) with minimal side effects.
  • Once a patient is on stable therapy, combination inhalers have the advantage of ensuring a long-acting beta2 agonist is not used without inhaled steroid.
  • In adults at step 3 who are poorly controlled, the use of budesonide/formoterol in a single inhaler as rescue medication instead of a short-acting beta2 agonist, in addition to its regular use as a controller treatment, is an effective treatment option but requires careful patient education.

Difficult asthma

  • Defined as persistent symptoms and/or frequent exacerbations despite treatment at step 4 or 5.
  • Systematically evaluate patients including confirmation of the diagnosis of asthma, identification of the mechanism of persisting symptoms and adherence with therapy.
  • Assessment should be facilitated through a dedicated multidisciplinary difficult asthma service.

The full guideline is available from www.sign.ac.uk and www.brit-thoracic.org.uk or there is a MIMS summary of the stepwise management in the Guidelines section.

Want news like this straight to your inbox?
Sign up for our bulletins

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register
Already registered?
Sign in

Register or Subscribe to MIMS

GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! If you're not a GP, you can subscribe to MIMS for full access.

Register or subscribe

MIMS Dermatology

Read the latest issue online exclusively on MIMS Learning.

Read MIMS Dermatology

MIMS Adviser

Especially created for prescribing influencers.

Request free copy

Mobile apps

MIMS: access the full drug database and quick-reference tables on the go

MIMS Diagnosis and Management: concise information on signs and symptoms, investigations and diseases