Poorly controlled asthma: treatment options in the joint NICE/BTS/SIGN guideline

Introduction

The majority of people with asthma in the UK are usually managed in primary care.  However, not all patients’ asthma is well controlled on  conventional therapies of inhaled corticosteroids (ICS) plus short-acting bronchodilator (SABA) or ICS plus long-acting bronchodilators (LABA), and for some people, treatment needs to be escalated to achieve good control.

Furthermore, the National Review of Asthma Deaths (NRAD) revealed that many of the people who died of asthma were being treated for ‘mild to moderate’ asthma,¹ indicating a need for more careful consideration of diagnosis, the control (or lack of control) of symptoms and treatment options.

Until recently, the main therapy options for people with poorly controlled asthma were to increase the dose of ICS, add a long-acting beta2 agonist and to consider additional treatment options such as a leukotriene receptor antagonist, slow release theophylline or oral beta2 agonists.² There is now ample evidence for ICS/formoterol combination inhaler - as needed anti-inflammatory-reliever (AIR) - and maintenance and reliever (MART) regimens.³ 

This resource is offered at an advanced level. Complete the module by reading the article, Guidelines in a nutshell: NICE - the final joint guidance on asthma, reflecting on the information and answering the following questions  to consolidate your knowledge. Save your additional reading articles in MY FOLDERS and complete the activities/reflections, considering how this module reflects the NMC Code. On completion, you can obtain a certificate for one hour of continuing professional development to add to your revalidation portfolio.

Aims and objectives

On completion of this module, you should have an understanding of:

• The ways of assessing asthma control and the definition of good asthma control
• The evidence for AIR and MART approaches to asthma management
• The treatment options for the management of inadequately controlled asthma
• When specialist input should be sought for people with asthma

References/Further reading

1. Royal College of Physicians. Why asthma still kills: The National Review of Asthma Deaths (NRAD), 2014 https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills

2. British Thoracic Society/Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma, 2016 https://www.sign.ac.uk/pdf/SIGN153.pdf

3. Bostock B. Anti-inflammatory reliever therapy for asthma: putting evidence into practice. Practice Nurse 2023(5):26-30 

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