New resources have been published for diagnosing and managing severe asthma as PCRS prepares to publish its own Poorly Controlled and Severe Asthma Pragmatic Guide.
These resources are:
- A Guide to Difficult-to-Treat and Severe Asthma in Adolescent and Adult Patients published by GINA (The Global Initiative for Asthma). It summarises the steps involved in assessing and treating adolescents or adults who present with difficult-to-treat asthma. A clinical decision tree provides brief information about what should be considered at each stage. The first four of eight sections are for use in primary care. The other sections inform the primary care team about the treatment strategies and therapies available to the patients they refer to secondary care.
- New draft guidance from NICE recommends benralizumab for patients with severe eosinophilic asthma who have struggled to control it with inhalers. Benralizumab is a biological therapy which targets and depletes eosinophils in the blood. It is the third biological treatment for severe eosinophilic asthma approved by NICE, following approval of mepolizumab and reslizumab. People who are eligible for mepolizumab or reslizumab can now be offered benralizumab. The final technology appraisal document is due to be published next month.
- NICE has also recommended bronchial thermoplasty for severe asthma. This procedure, involves applying heat to the inside walls of the airways.
The PCRS Poorly Controlled and Severe Asthma Pragmatic Guide has been commissioned to provide practical, implementable guidance on the identification of patients requiring referral for specialist review because their asthma is poorly controlled or severe and not effectively managed with readily available treatments. The consensus guidance is being developed by an expert group led by GP Dr Steve Holmes, PCRS member and clinical lead for severe asthma.
Dr Holmes said: “It is time for us to move forwards in asthma management - and really help our patients to optimise their quality of life and their potential. For too long both clinicians and our patients have accepted suboptimal control, frequent use of emergency reliever therapy, attendance at AE&, hospital admissions and oral steroid use.
“If we can get the basics right in generalist practice - we will make a significant difference to many of our patients. If we have patients who are not settling we should be thinking of involving clinicians with more time and expertise to disentangle asthma from other causes of breathlessness that may co-exist. And if we have difficult-to-control asthma linked to disease severity we should be able to treat and monitor these patients according to their specific phenotypes and again improve care.”