Author: Dr Andrew Whittamore, Asthma UK's in-house GP
Date: 29 November 2017
How asthma is diagnosed and treated – updated guidelines from NICE
Newly launched asthma guidelines from NICE (National Institute of Clinical Excellence) recommend new approaches to how asthma is diagnosed and treated. The changes, which apply to NHS asthma services in England, are focused on improving the accuracy of diagnosis, and introducing more effective treatment and monitoring of asthma.
These new guidelines will give healthcare professionals more certainty when they diagnose people with asthma. We know that an accurate, timely diagnosis is vital, so people with asthma can be treated with the right medicines that can make such a big difference to their symptoms and quality of life.
NICE guidelines on asthma diagnosis
A key part in diagnosing asthma is talking through with your GP your medical and family history, your symptoms and triggers, and when you notice symptoms are worse, to see whether asthma is likely. If asthma is suspected, tests are used to confirm the diagnosis.
New NICE guidelines now recommend that diagnostic tests are carried out before giving treatment. And because no one test is reliable enough to consistently diagnose asthma, a combination of tests - including spirometry, FeNO and peak flow testing - is recommended as a more effective way to confirm or rule out asthma before a treatment plan is drawn up. This will help you and your GP feel more confident that you're getting the right treatment for your symptoms.
Guidelines for babies and children under 5 are different. For this age group tests are not reliable, and here NICE continues to recommend a 'trial of treatment' with close monitoring to see if asthma medicines make a difference. As soon as a young child is able to do breathing tests they should be used to confirm the diagnosis.
NICE guidelines on treatment of asthma
Most people with asthma have two types of asthma medicine: preventer medicine to take every day (usually a preventer inhaler), and reliever medicine to relieve symptoms when needed. This hasn't changed.
But the NICE guidelines do recommend a new approach to how we treat people with asthma whose symptoms are not sorted by the steroid preventer inhaler alone. Previously at this point most people were offered a combination inhaler – containing both a preventer and a long-acting reliever. Now guidelines recommend patients in England are offered a tablet called an LTRA (leukotriene receptor antagonist) to take alongside the preventer inhaler for 4-8 weeks to see if it makes a difference. NICE makes this recommendation based on the evidence of what will be best for patients, but also considers the economic cost to the NHS – with LTRA coming out as more cost-effective than a combination inhaler.
If you're already on a combination inhaler already, and your asthma is well controlled, then there is no need to change your treatment.
Asthma UK welcomes any guidelines that look at improving the diagnosis and treatment of asthma. Guidelines, used alongside your healthcare professional's clinical judgement, help get the right care for you, based on the latest evidence. The most important thing is that your asthma care is personalised. This means your healthcare professional considers your preferences, other medical conditions you have, or medicines you're taking, as well as how good you are at taking and remembering your medicines. All this, alongside expert clinical guidelines, needs to be taken into account when deciding how to treat your asthma.
NICE recognise that putting these guidelines into practice might take time, money and training- not everyone in England will have NICE standards of care immediately. If the NICE guidelines are not implemented in your area (you don't live in England, or your local NHS have not implemented it yet) don't worry. Alternative guidelines are not wrong, or unsafe, but NICE have tried to improve the accuracy of diagnosis and improve the cost-effectiveness of treatment of asthma.
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