Asthma guidance – part 1
The Scottish Intercollegiate Guidelines Network (SIGN) and British Thoracic Society (BTS) published their British guideline for the management of asthma in September 2016. This was followed in November 2017 by the publication by NICE of Asthma: diagnosis, monitoring and chronic asthma management.
Discrepancies between the two guidelines have the potential to introduce uncertainty for clinicians and inconsistencies in the care of individual patients. Resolution has been provided, for primary care practitioners and commissioners alike, in ‘Asthma Guidelines in Practice – a PCRS-UK Consensus’, written by Luke Daines (GP and Academic Clinical Fellow, University of Edinburgh) and various GP and nurse colleagues.
For diagnosis, the Consensus broadly supports the BTS/SIGN position, and reasserts the primary importance of good clinical method and regular assessments. In line with NICE, it recommends investigating the creation of diagnostic hubs to provide diagnostic services not currently available in primary care.
As regards treatment, it accepts the cost-benefit rationale for leukotriene receptor antagonists as add-on treatment after low-dose inhaled corticosteroids.
The authors call for collaboration between NICE and BTS/SIGN in developing a single asthma guideline, a view further elaborated by Noel Baxter and Duncan Keeley in an article recently published in BMJ entitled ‘Conflicting asthma guidelines cause confusion in primary care’.