The Scottish Intercollegiate Guidelines Network (SIGN) and the British Thoracic Society (BTS) have updated their joint guideline on the management of asthma. The latest version includes changes to the recommended monitoring and pharmacological treatment of asthma, and a new section on asthma in adolescents.
The main changes in the pharmacological management section are as follows:
- As CFC-based beclometasone inhalers are no longer available, doses of inhaled steroids are now referenced against HFA-propelled beclometasone. HFA-based preparations should be prescribed by brand as some are more potent than others.
- When switching from CFC-propelled beclometasone to Qvar, the dose of beclometasone should be maintained if asthma control is poor on the CFC product but halved if control is good.
- Long-acting β2 agonists (LABAs) should only be used in patients who are already on inhaled corticosteroids, and the inhaled corticosteroid should be continued. Combination inhalers are recommended to improve adherence and ensure that the LABA is not taken without inhaled steroid.
- Children under specialist care may benefit from a trial of high-dose inhaled corticosteroids (greater than 800 microgram/day) before moving to oral steroids.
- Growth should be monitored in children receiving steroids and bone mineral density should also be monitored in steroid-treated children under 5 years of age.
The new section on adolescents notes that asthma is underdiagnosed in this age group and recommends that patient inhaler preference be taken into account in order to improve adherence.