New UK asthma guideline: meeting the challenge to change

Asthma is a common inflammatory airway condition that affects around six million people in the UK.1 Despite better understanding of the underlying nature of the condition and greater availability of effective treatments,2 asthma remains a serious challenge.3 Inaccurate diagnosis and delayed access to appropriate treatment are longstanding problems that still disadvantage patients.456 Those problems have not been helped by inconsistencies between the guidelines from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN)7 and the National Institute for Health and Care Excellence (NICE).8 Furthermore, treatments and approaches have advanced since the BTS/SIGN guidelines were last revised nearly six years ago.9 The new joint BTS/SIGN/NICE guideline’s “focused reset” of approaches to diagnosing and treating asthma is therefore welcome and long overdue.10

On diagnosis, the new guideline emphasises upfront confirmation of inflammatory traits characteristic of asthma—that is, raised levels of blood eosinophils and fractional exhaled nitric oxide (FeNO). Measures of variable airflow limitation (bronchodilator reversibility or peak flow variability) or airway hyper-responsiveness follow later in the diagnostic pathway for adults, as does skin prick testing for allergies in children.

The guideline moves away from starting treatment with inhaled short acting ß₂ agonists, instead …