The British Thoracic Society (BTS) has published an article on the BMJ/Thorax blog which gives an overview of the key differences between the BTS/SIGN and NICE guidelines on the diagnosis and management of asthma.
This can be read alongside the PCRS-UK briefing paper which looks in detail at the two guidelines and makes recommendations about the most practical approach to the guidelines for primary care.
The BTS article highlights the differences in detail between the two guidelines but, unlike the PCRS-UK briefing paper, does not give an opinion on the areas where the guidelines diverge.
It examines the discrepancies in recommendations made by both guidelines and seeks to provide some context to these differences in the key areas of:
- Pharmacological management
- Treatment at diagnosis
- The introduction of leukotriene receptor antagonists (LTRA) after low dose inhaled corticosteroids (ICS)
- Maintenance and reliever therapy (MART)
- Treatment beyond combined inhaler therapy
- Some other issues in managing asthma in children
The article points out that the BTS/SIGN guideline also provides recommendations for important aspects of asthma management that are not addressed within NICE guidelines. These include guidance on inhaler devices, the management of acute asthma attacks in both adults and children, the management of difficult asthma, guidance on asthma in adolescents, in pregnant women and on occupational factors.
The authors say: “It is hoped that this examination of the differences highlighted in this article will assist clinicians in making decisions with their patients. Our understanding of asthma is evolving and our assessment of treatments must evolve with it. Further research to clarify the areas where data are currently limited or absent is urgently required in order that further updates can offer the best evidence based advice.”
This article is currently in press and BTS advises that it may be subject to minor content and format changes before publication in the February 2018 issue of Thorax.