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Asthma guidelines: which is the best of three?

02 August 2020
Volume 31 · Issue 8


Andrew Booth offers a comprehensive look into national and international guidelines surrounding the diagnosis and management of asthma

National and international guidelines provide evidence-based advice on the diagnosis and management of asthma. There are now three potential asthma guidelines to follow, each taking its own unique, and sometimes conflicting direction, creating a total of over 700 pages of high-quality evidence. A puzzle is thus presented to the busy health professional: which guideline do I follow? This article compares and contrasts two national and one international asthma guideline, focusing particularly on diagnosis and pharmacological management. Mortality from asthma is increasing in the UK, making the need for a conjoined guideline more urgent than ever.

Asthma deaths are increasing, despite a plethora of published evidence and guidelines. From a low of 997 deaths in England and Wales in 2009, the number rose to 1392 in 2018 (Office for National Statistics, 2020). In the UK, three people die of asthma every day (Asthma UK, 2018).

The National Review of Asthma Deaths (NRAD) found that there was a lack of health professional knowledge of the UK guidelines in 25% of asthma deaths reviewed. The expert NRAD panels identified factors that could have avoided death in relation to the health professional's implementation of asthma guidelines in 46% of cases, with a specific lack of asthma expertise in 17% of cases (Royal College of Physicians (RCP), 2014). Although it has been alleged that only one of the 19 recommendations from this report have been currently implemented (Levy, 2018), various national initiatives have been taken forward, including the inclusion of respiratory disease in The NHS Long Term Plan (NHS England and NHS Improvement, 2019), changes to the Quality Outcomes Framework, the National Asthma Audit, and guidance for asthma from the National Institute for Health and Care Excellence (Asthma UK Centre for Applied Research, 2020).

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