Long-awaited joint asthma guidance from NICE and the British Thoracic Society/ Scottish Intercollegiate Network (SIGN) will finally be published next summer, Pulse has learned.
Proposals to develop a single set of guidelines from the three organisations was first announced in 2019 after concerns that conflicting advice in their recommendations was causing confusion.
This included around the use of FeNO testing with BTS/SIGN saying it should be used where available and NICE advising its use routinely.
BTS/SIGN said at the time they had agreed to work with NICE to produce a joint UK-wide guideline for the diagnosis and management of chronic asthma in the future.
After a delay due to the pandemic, it was announced in 2021 that committee members were being appointed and a process agreed.
Draft guidelines are expected for consultation in February with the final publication due on the 31st July.
The BTS has previously commented that having two sets of guidance leads to inconsistency and uncertainty.
It is hoped the new guidance will provide ‘an integrated pathway for managing chronic asthma’, they added.
There has been much debate over the years around the differences between NICE and BTS/SIGN guidelines around diagnosis and treatment of asthma
Jon Foster, policy manager at Asthma + Lung UK, said: ‘Having one clear set of guidelines for healthcare professionals is vital to ensure standardised asthma care across the healthcare service, so that people with asthma can receive the care they deserve. This is a huge opportunity to take on some of the significant issues holding back asthma care in the UK, including overprescribing of reliever inhalers, lack of annual asthma reviews and patchy access to life-changing biologic drugs for severe asthma.
‘But while simplified guidelines will be helpful to GPs, we know that the biggest problem they face is lack of resources to accurately diagnose and help people manage their asthma, with no central funding for basic diagnostic tests for lung conditions – the Government urgently needs to address this.’
Dr Steve Holmes, a GP in Shepton Mallet in Somerset and member of the Primary Care Respiratory Society said good evidence-based guidelines were always of value.
‘I am certainly looking forward to the BTS/SIGN/NICE guidelines on asthma due for publication next year – and in discussions with colleagues and patients across [primary and secondary care] boundaries they would agree with this.’
Dr Dermot Ryan, retired GP and director of the International Primary Care Respiratory Group said in his personal opinion it is not possible to say at this point what the guidelines will look like, but he was pleased at least to see there was good GP representation on the committee.
He added that current NICE guidelines were piecemeal and had not considered many issues that were relevant to patients and clinicians, including funding of FeNO testing in primary care that had been suggested in the 2017 guideline.
‘Of great importance is that NICE in their wisdom decided in 2021 not to perform an evidence review on management of acute asthma, difficult asthma, asthma in adolescents and in pregnancy, supported self management, step down treatment, occupational asthma or organisation of care delivery which should of course include thresholds of when to refer for specialist assessment and ensuring that sufficient resources were available to meet the current unmet needs,’ he explained.
Dr Ryan added that the cost-effectiveness approach of NICE and the ‘clinical excellence’ approach of BTS/SIGN was unlikely to produce ‘harmony’.
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This will be very helpful as our local paediatric respiratory service have rejected referrals as ‘we are not commissioned to diagnose asthma’ (!). Presumably this was an active decision with clinical communication, clear governance, updates of service specification with commissioners, clinical sign off, risk mitigation and paperwork to support GPs not following NICE guidelines, but if it was I must have missed it and no one from the referral rejecting Trust nor the commissioners has got back to me with that info!
Ah yes – the NICE asthma guidelines. The point at which NICE finally made it clear that they do not consider “reality” to be a valid constraint on their glorious imaginations.