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Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE

John White, James Y Paton, Robert Niven, Hilary Pinnock, on behalf of the British Thoracic Society.
Thorax 2018; published online 03 January 2018
doi: 10.1136/thoraxjnl-2017-211189

There are at least two national guidelines for the diagnosis and monitoring, and management of asthma in England: the British Thoracic Society/Scottish Intercollegiate Guideline Network (BTS/SIGN) guidelines, last published in 2016, and the National Institute for Health and Care Excellence (NICE) guideline on asthma diagnosis and monitoring and chronic asthma management, published in 2017. While the evidence base used by both guideline development groups is broadly the same, the recommendations are based on significantly different methodology. BTS/SIGN and NICE methodology both employ robust critical appraisal of the literature, but methodologies diverge after that: BTS/SIGN considers pragmatic studies to ensure their guidelines provide clinically robust recommendations, while NICE employs health economic modelling, with interpretation supported by advice from a multidisciplinary Guideline Development Group.

To help clinicians in the care of people with asthma, the BTS has issued a statement, written by John White, James Paton, Robert Niven and Hilary Pinnock, which considers the similarities and differences. The statement provides context for these differences in the areas of diagnosis and pharmacological management, with the latter broken down into key areas: treatment at diagnosis, the introduction of leukotriene receptor antagonist after low-dose inhaled corticosteroids, maintenance and reliever therapy, treatment beyond combined inhaler therapy and issues in managing asthma in children. The statement also highlights recommendations in the BTS/SIGN guidelines regarding aspects of asthma management not addressed in the NICE guidelines, including 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.

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