NICE overturns advice to increase steroid dose in children with asthma

NICE has withdrawn its recommendation to quadruple the dose of inhaled corticosteroids (ICS) in children when their asthma control deteriorates.

Further research is needed to give clearer guidance on increasing the dose of inhaled corticosteroids in children with asthma. | GETTY IMAGES
Further research is needed to give clearer guidance on increasing the dose of inhaled corticosteroids in children with asthma. | GETTY IMAGES

In a review and update of its 2017 guidance on asthma diagnosis, monitoring and management, NICE said that increasing the dose of ICS to manage deteriorating asthma control in children did not provide any benefits in terms of reducing subsequent asthma exacerbations.

Reviewing the evidence for the original recommendation, the guideline committee concluded that it was limited to a small number of studies, mostly in adults, and that the best available research did not support the practice.

For children and young people aged 5 to 16 with deteriorating asthma who have not been taking their ICS consistently, NICE says restarting regular use may help them to regain control of their asthma.

The guideline committee added that there was no significant evidence that increasing the dose of ICS is harmful, so children could continue to do this if they find it helpful and it is part of an agreed strategy in their asthma action plan.

Personalised action plan

The guidance emphasises the importance of keeping young asthma patients under review and following an individualised approach when drawing up an action plan for managing their condition.

It says that children with asthma should have advice included in their action plan about contacting a healthcare professional for a review if their asthma control deteriorates.

NICE expects the updated recommendations to lead to an increase in the review of asthma action plans for young people and reduce the variation in current practice. It says studies have shown that most child asthma deaths involve children who have frequent but mild symptoms that are not responding to management in their personalised action plan.

Dr Noel Baxter, from the Primary Care Respiratory Society, said: 'This guidance should focus our minds on preventing attacks because the same intervention of rescue with increased ICS seen in adults is not replicated in under 16s and so we have one less proven intervention before we opt for oral corticosteroids. Personal asthma action plans prevent asthma attacks and ensuring children and parents or carers understand the condition to improve adherence and early recognition of worsening is key.'

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