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Asthma

Description: Assessment and treatment of asthma in adults and children

Publet Introduction:

The BTS/SIGN guideline on which this publet is based now carries the caution that it “is not intended to be construed or to serve as a standard of care. Standards of care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. Adherence to guideline recommendations will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement must be made by the appropriate healthcare professional(s) responsible for clinical decisions regarding a particular clinical procedure or treatment plan. This judgement should only be arrived at following discussion of the options with the patient, covering the diagnostic and treatment choices available. It is advised, however, that significant departures from the national guideline or any local guidelines derived from it should be fully documented in the patient’s case notes at the time the relevant decision is taken”.

History

In 1999 the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) agreed to jointly produce a comprehensive new asthma guideline, both having previously published guidance on asthma. The original BTS guideline dated back to 1990 and the SIGN guidelines to 1996. Both organisations recognised the need to develop the new guideline using explicitly evidence based methodology. The joint process was further strengthened by collaboration with Asthma UK, the Royal College of Physicians of London, the Royal College of Paediatrics and Child Health, the General Practice Airways Group (now Primary Care Respiratory Society UK), and the British Association of Accident and Emergency Medicine (now the College of Emergency Medicine). The outcome of these efforts was the British Guideline on the Management of Asthma published in 2003.

	Information
Guideline Objectives	This guideline provides recommendations based on current evidence for best practice in the management of asthma. It makes recommendations on management of adults, including pregnant women, adolescents, and children with asthma. In sections 6 and 7 on pharmacological management and inhaler devices respectively, each recommendation has been graded and the supporting evidence assessed for adults and adolescents over 12 years old, children 5–12 years, and children under 5 years. In section 10 recommendations are made on managing asthma in adolescents (10–19 years of age as defined by the World Health Organisation (WHO).4 The guideline considers asthma management in all patients with a diagnosis of asthma irrespective of age or gender (although there is less available evidence for people at either age extreme). The guideline does not cover patients whose primary diagnosis is not asthma, for example those with chronic obstructive pulmonary disease or cystic fibrosis, but patients with these conditions can also have asthma. Under these circumstances many of the principles set out in this guideline will apply to the management of their asthma symptoms. The key questions on which the guideline is based can be found on the SIGN website, www.sign.ac.uk, as part of the supporting material for this guideline.
Target Setting	Primary and hospital care
Target Users	Author Release Date
Overview	Asthma is a common condition which produces a significant workload for general practice, hospital outpatient clinics and inpatient admissions. It is clear that much of this morbidity relates to poor management particularly the under use of preventative medicine.
Provenance	7.No provenance has been assigned (default value)
Management	This guideline provides recommendations based on current evidence for best practice in the management of asthma. It makes recommendations on management of adults, including pregnant women, adolescents, and children with asthma. In sections 6 and 7 on pharmacological management and inhaler devices respectively, each recommendation has been graded and the supporting evidence assessed for adults and adolescents over 12 years old, children 5–12 years, and children under 5 years. In section 10 recommendations are made on managing asthma in adolescents (10–19 years of age as defined by the World Health Organisation (WHO).4 The guideline considers asthma management in all patients with a diagnosis of asthma irrespective of age or gender (although there is less available evidence for people at either age extreme). The guideline does not cover patients whose primary diagnosis is not asthma, for example those with chronic obstructive pulmonary disease or cystic fibrosis, but patients with these conditions can also have asthma. Under these circumstances many of the principles set out in this guideline will apply to the management of their asthma symptoms. The key questions on which the guideline is based can be found on the SIGN website, www.sign.ac.uk, as part of the supporting material for this guideline.
Safety Case
Sources	See BTS/SIGN guideline
References	See BTS/SIGN guideline