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NICE overturns current practice of multiplying ICS doses for child asthma attacks


NICE has overturned a 2017 recommendation to quadruple the dose of inhaled corticosteroids for children when their asthma control deteriorates.

The NICE advisory committee which has made the changes, following input from experts including PCRS, says the previous guidance was based on limited evidence, mostly in adults, and that the best available research did not support this practice.

However, the committee added that there wasn't any significant evidence to suggest that increasing the dose of ICS is harmful so children could continue to do this, if they find it helpful as a strategy and is part of a personalised asthma action plan.

The change is included in a final update to NICE’s guideline on asthma diagnosis, monitoring and chronic management.

It recommends:

  • That young people aged 5 to 16 with a diagnosis of asthma, should have a self-management programme that advises them to contact a healthcare professional for a review if their asthma control deteriorates.
  • Young patients with deteriorating asthma, who have not been taking their ICS consistently should be told that:
  • restarting regular ICS use may help them regain control of their asthma
  • evidence for increasing ICS doses to self-manage deteriorating asthma control is limited

The guidance stresses the importance of keeping young asthma patients under review and following an individualised approach when it comes to drawing up an action plan for managing their condition.  NICE says it hopes that the new recommendations will lead to an increase in the review of asthma action plans for young people and reduce the variation in current practice. It says: “Studies have shown that most child asthma deaths involve children who have frequent but mild symptoms that are not responding to management in their personalised action plan.”

PCRS Policy Lead Noel Baxter says: “This guidance should focus our minds on preventing attacks because the same intervention of rescue with increased ICS seen in adults is not replicated in under 16s and so we have one less proven intervention before we opt for oral corticosteroids. Personal asthma action plans prevent asthma attacks and ensuring children and parents or carers understand the condition to improve adherence and early recognition of worsening is key.”

These resources offer PCRS expert advice on asthma: