Excerpt

Asthma is the most commonly diagnosed long-term medical condition in the UK, affecting over 5 million people, of whom over 1 million are children (Asthma UK). The underlying pathology varies, but in general there is chronic inflammation of the lining of the airways that releases inflammatory mediators which trigger the smooth muscle of the airway to contract and narrow the air passages. The narrowing results in symptoms such as wheeze, cough, chest tightness and breathlessness. These symptoms can be measured by lung function tests that show evidence of airway obstruction and airway inflammation. A key feature of asthma is that the airway obstruction is reversible with medical treatment that relaxes the airway smooth muscle.

The aim of this guideline is to provide clear advice for healthcare professionals and people with asthma to develop a personalised action plan. The plan should support self-management of asthma, and ensure that the person is receiving the best possible treatment for their current level of illness.

The guideline covers children under 5, children and young people aged 5–16 and adults over 16 with suspected or diagnosed asthma. It focuses on the pharmacological management of chronic asthma, in particular the treatment pathway for people with uncontrolled asthma. It also covers adherence to treatment, risk stratification and self-management.

The guideline does not cover the management of acute asthma attacks.

Contents

• Guideline Committee members
• NGC technical team members
• Co-optees
• Acknowledgements
• 1. Guideline summary
  • 1.1. Algorithms
  • 1.2. Full list of recommendations
  • 1.3. Key research recommendations
• 2. Introduction
• 3. Development of the guideline
  • 3.1. What is a NICE guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Identifying and analysing evidence of effectiveness
  • 4.4. Identifying and analysing evidence of cost effectiveness
  • 4.5. Developing recommendations
• 5. Treatment in patients not on regular preventers
  • 5.1. Introduction
• 6. Choice of first-line preventer in patients with poor asthma control
  • 6.1. Introduction
• 7. Escalating pharmacological treatment in patients poorly controlled on low dose ICS
  • 7.1. Introduction
• 8. Intermittent versus daily ICS with seasonal or trigger-specific symptoms
  • 8.1. Introduction
• 9. Improving adherence to treatment
  • 9.1. Introduction
• 10. Self-management plans
  • 10.1. Introduction
• 11. Dose variation within self-management plans
  • 11.1. Introduction
• 12. Decreasing regular maintenance therapy
  • 12.1. Introduction
• 13. Breathing exercises in addition to pharmacological treatment
  • 13.1. Introduction
• 14. Managing patients in relation to risk of poor outcomes
  • 14.1. Introduction
• 15. Reference list
• 16. Acronyms and abbreviations
• 17. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Clinical review protocols
  • Appendix D. Health economic review protocol
  • Appendix E. Clinical study selection
  • Appendix F. Health economic study selection
  • Appendix G. Literature search strategies
  • Appendix H. Clinical evidence tables
  • Appendix I. Health economic evidence tables
  • Appendix J. GRADE tables
  • Appendix K. Forest plots
  • Appendix L. Excluded clinical studies
  • Appendix M. Excluded health economic studies
  • Appendix N. Cost-effectiveness analysis for second line preventers
  • Appendix O. Unit costs
  • Appendix P. Research recommendations
  • Appendix Q. Additional information
  • Appendix R. NICE technical team
  • Appendix S. References

Final version

Commissioned by the National Institute for Health and Care Excellence

Disclaimer: Healthcare professionals are expected to take NICE guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and, where appropriate, their guardian or carer.

Update information March 2018: Some of the algorithms were updated to clarify when actions should be taken and to show that medicines should be decreased once asthma is controlled.