Updated drug treatment recommendations include the following:
•In asthma action plans for adults, health professionals are advised to consider quadrupling the level of inhaled corticosteroids (ICS) at the onset of an asthma attack - and if necessary for up to 14 days after - in order to abort the attack and the need for ongoing oral steroids. Health professionals need to weigh up the benefit/risk ratio of the strategy in people already on high dose ICS - especially if they are experiencing frequent asthma attacks.
•If asthma symptoms are still problematic after use of ICS - the next ‘add on’ treatment recommended is an inhaled long-acting beta agonist (LABA). If this fails to gain control, increase the dose of ICS from low to medium dose in adults or from very low dose to low dose in children (5–12 years). At this stage health professionals can also consider a leukotriene receptor antagonist as an ‘add on’ treatment.
•Health professionals should consider the option of combined maintenance and reliever therapy (MART) in adult patients who have a history of asthma attacks on medium dose ICS or ICS/LABA.
It has been announced that future UK-wide guidance for the diagnosis and management of chronic asthma in adults, young people and children will be produced jointly by the British Thoracic Society (BTS), Scottish Intercollegiate Guideline Network (SIGN) and NICE. 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’. Representatives of each organisation will work closely together over the coming months to develop a detailed scope, workplan and timeline for the new venture.