19 August 2019

An update to the British guideline on the management of asthma, developed jointly by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN), has been published. This guideline, first published in 2003, provides recommendations based on current evidence for best practice in the management of asthma. The 2019 update includes a complete revision of the diagnosis of asthma and a major update to the pharmacological management, as well as revisions to the sections on supported self and non-pharmacological management, management of acute asthma, difficult asthma and organisation and delivery of care.

Key highlights in the updated 2019 asthma guideline are:

  • Key recommendations (Section 2)/Monitoring asthma (Section 4): guidance has been added for health professionals to assess all patients for risk of future asthma attacks to help tailor care and treatment. Core components of an asthma review should be assessed at least annually and should include a review of current symptoms, future risk of attacks, management strategies and, additionally, growth in children.
  • Supported self-management (Section 5): in asthma action plans, health professionals should consider increasing inhaled corticosteroids at the onset of an asthma attack in order to reduce the risk of needing oral steroids.
  • Pharmacological management (Section 7): guidance has been added for patients to be referred for specialist care when their asthma is not adequately controlled on recommended initial or additional controller therapies, as the choice and administration of new therapies is complex.
  • Inhaler devices (Section 8): prescribers, pharmacists, and patients should be aware of the significant differences in the global warming potential of different asthma inhalers, using those with a lower carbon footprint, as long as they are equally effective. Patients are encouraged to recycle their used inhalers where possible following advice from the pharmacy.
  • Provision of information (Section 15): a new checklist has been included as an aid for patients and carers to use at key stages, from assessment/diagnosis to monitoring and management of attacks.

The document will form part of a broader set of guidance and materials, produced by BTS, SIGN and NICE, on diagnosing and managing asthma throughout an individual’s lifetime – a new ‘asthma pathway’.