NICE advises on use of inhaled steroids

NICE has issued guidance on the use of inhaled corticosteroids for the treatment of chronic asthma in adults and children aged 12 years and over.

Step 2 of the BTS/SIGN guidelines1 on the management of asthma in adults recommends the introduction of regular preventer therapy with inhaled corticosteroids.


Add-on therapy (Step 3) involves the introduction of an additional therapy, the first choice of which is an inhaled long-acting ß2-agonist (LABA).


The new NICE guidance recommends the following:

  • For patients with chronic asthma in whom an inhaled corticosteroid is considered appropriate the least costly product should be prescribed, assuming that the product is suitable for the individual and is prescribed within its licence.
  • For patients in whom treatment with both an inhaled corticosteroid and a LABA is considered necessary the use of a combination inhaler device is an option. In this instance the least costly product that is suitable for the individual should be prescribed.
  • The decision on whether to use a combination device or the two agents in separate devices should be made on an individual basis, taking into consideration therapeutic need and the likelihood of treatment adherence.

Following a review of the available evidence the NICE appraisal committee concluded that when comparing the different inhaled corticosteroids, either at low or high doses, there was no difference between them in terms of effectiveness. It also concluded that adding a LABA is more effective than continuing on the same or an increased dose of inhaled corticosteroid.


When considering simultaneous treatment with an inhaled corticosteroid and a LABA the committee concluded that it was reasonable to assume that there was no significant difference in effectiveness when these were administered in a combination device as opposed to separate devices. However, it accepted that the use of a single combination device is likely to be associated with significantly improved adherence.


The full guideline is available at www.nice.org.uk

1. British Thoracic Society/Scottish Intercollegiate Guidelines Network (and others). Guidelines on Asthma Management. Available from www.brit-thoracic.org.uk and www.sign.ac.uk

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