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British Guideline on the MAnAGeMent of AsthMA 11 development of the guideline 11.1 introduCtion 106 The guideline has been developed by multidisciplinary groups of practising clinicians using a standard methodology based on a systematic review of the evidence. Further details about SIGN and the guideline development methodology are contained in “SIGN 50: A Guideline Developer’s Handbook”, available at www.sign.ac.uk Development involved the work of ten different multidisciplinary evidence review groups, a steering group and an executive group, chaired jointly by Dr Bernard Higgins on behalf of the BTS and Dr Graham Douglas on behalf of SIGN. All members of the guideline development group made declarations of interest and further details of these are available on request from the SIGN Executive. Guideline development and literature review expertise, support and facilitation were provided by the SIGN Executive. 11.2 exeCutive And steerinG GrouPs Dr Graham Douglas* Consultant Respiratory Physician, (Co-chair) Aberdeen Royal Infirmary Dr Bernard Higgins* Consultant Respiratory Physician, (Co-chair) Freeman Hospital, Newcastle upon Tyne Professor Neil Barnes Consultant Respiratory Physician, Barts and The London NHS Trust Dr Anne Boyter Senior Lecturer, Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow Professor Sherwood Burge Consultant Respiratory Physician, Birmingham Heartlands Hospital Ms Elaine Carnegie Asthma Policy, Asthma UK Scotland Dr Chris Cates* Senior Research Fellow, St George’s, University of London Dr Gary Connett Consultant Paediatrician, Southampton General Hospital Dr Jon Couriel* Consultant in Paediatric Respiratory Medicine, Alder Hey Children’s Hospital, Liverpool Dr Paul Cullinan Consultant Physician/Reader, Imperial College, London Dr Graham Devereux* Consultant in Thoracic Medicine, Aberdeen Royal Infirmary Ms Monica Fletcher* Chief Executive, Education for Health, Warwick Professor Chris Griffiths Professor of Primary Care, Institute of Health Science Education, London Dr Liam Heaney Senior Lecturer in Respiratory Medicine, Queen’s University, Belfast Dr Steve Holmes General Practitioner and Chair, General Practice Airways Group, Somerset Dr Roberta James* Acting Programme Director, SIGN Executive Ms Jan Manson Information Officer, SIGN Executive Mrs Ruth McArthur Practice Nurse/National Training Co-ordinator, Education for Health, East Kilbride Mr Michael McGregor Lay Representative, Edinburgh Dr Cathy Nelson-Piercy Consultant Obstetric Physician, St Thomas’ Hospital, London
Dr James Paton* Reader and Honorary Consultant Paediatrician, Royal Hospital for Sick Children, Glasgow Professor Ian Pavord* Consultant Physician/Honorary Professor of Medicine, Glenfield Hospital, Leicester Miss Cher Piddock Clinical Lead, Care Development Team, Asthma UK Dr Hilary Pinnock General Practitioner, Whitstable Medical Practice, Kent Professor Colin Robertson Consultant in Emergency Medicine, Edinburgh Royal Infirmary Professor Mike Shields Professor of Child Health, Queen’s University, Belfast Dr Stephen Turner Clinical Senior Lecturer, Royal Aberdeen Children’s Hospital Ms Sally Welham* Deputy Chief Executive , British Thoracic Society, London Dr John White Consultant Respiratory Physician, York District Hospital * Executive group 11.3 evidenCe revieW GrouPs DIAGNOSIS Dr Jon Couriel Consultant in Paediatric Respiratory Medicine, (Co-chair) Royal Liverpool Children’s Hospital Dr James Paton Reader and Honorary Consultant Paediatrician, (Co-chair) Royal Hospital for Sick Children, Glasgow Professor Ian Pavord Consultant Physician/Honorary Professor of Medicine, (Co-chair) Glenfield Hospital, Leicester Professor Justin Beilby Head of the Department of General Practice, University of Adelaide, Australia Professor Anne Chang Head of Child Health Division, Menzies School of Health Research, Darwin and Royal Children’s Hospital, Brisbane, Australia Dr Peter Gibson Adult Respiratory Physician, John Hunter Chest Institute, New South Wales, Australia Professor Peter Helms Professor of Child Health, University of Aberdeen Dr Bernard Higgins Consultant Respiratory Physician, Freeman Hospital, Newcastle upon Tyne Mrs Ruth McArthur Practice Nurse/National Training Co-ordinator, Education for Health, East Kilbride Dr Sarah Mayell Specialist Registrar, Alder Hey Hospital, Liverpool Dr Dominick Shaw Specialist Registrar, City Hospital Campus, Nottingham Dr Mike Thomas Asthma UK Senior Research Fellow, University of Aberdeen/ General Practitioner, Gloucestershire Monitoring Professor Ian Pavord Consultant Physician/Honorary Professor of (Co-chair) Medicine, Glenfield Hospital, Leicester Dr Stephen Turner Clinical Senior Lecturer, Royal Aberdeen Children’s (Co-chair) Hospital Professor Andrew Bush Professor of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London 11 develoPMent of the Guideline 107
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101 British Guideline on the Manage
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British Thoracic Society Scottish I
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Revised 2011 Revised 2011 Revised 2
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1 introduction 1.1 the need for A G
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1.3.1 PATIENT vERSION Patient versi
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Table 1: Clinical features that inc
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Case detection studies have used sy
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2.1.6 CHILDREN WITH AN INTERMEDIATE
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2.3 suMMAry focus the initial asses
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2.4 diAGnosis in Adults The diagnos
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2.4.1 FURTHER INvESTIGATION OF PATI
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Table 6: Differential diagnosis of
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2.5.1 TREATMENT TRIALS AND REvERSIB
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A small prospective observational s
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Table 8: Summary of tools that can
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Measurement Methodology Asthma Cont
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Measurement Methodology Eosinophil
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3.1.2 FOOD ALLERGEN AvOIDANCE Sensi
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The limited data on antenatal or ea
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3.3.2 AIR POLLUTION Challenge studi
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3.5 CoMPleMentAry And AlternAtive M
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Revised 2011 4 Pharmacological mana
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Table 8b: Equivalent doses of inhal
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4.2.3 SAFETy OF INHALED STEROIDS Th
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4.3.2 ADD-ON THERAPy Options for ad
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4.4 steP 4: Poor Control on ModerAt
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4 PhArMAColoGiCAl MAnAGeMent Colchi
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MOVE UP TO IMPROVE CONTROL AS NEEDE
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4.6 stePPinG doWn Stepping down the
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4.7.5 ASPIRIN-INTOLERANT ASTHMA The
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Page 65 and 66: Patients with brittle or difficult
Page 67 and 68: Table 11: Initial assessment - the
Page 69 and 70: In acute asthma without life threat
Page 71 and 72: 6.3.8 ANTIBIOTICS 6.3.9 HELIOx When
Page 73 and 74: 6.6.2 PATIENT EDUCATION Following d
Page 75 and 76: 6.7.2 PULSE OxIMETRy 6.7.3 PEF Accu
Page 77 and 78: Frequent doses up to every 20-30 mi
Page 79 and 80: 6.9.3 Iv MAGNESIUM SULPHATE Intrave
Page 81 and 82: New 2011 7 special situations 7.1 A
Page 83 and 84: Gender During adolescence there is
Page 85 and 86: Complementary and alternative medic
Page 87 and 88: Table 13: Recommendations for organ
Page 89 and 90: 7.2 diffiCult AsthMA 7.2.1 DEFINING
Page 91 and 92: Revised 2009 Controlled studies usi
Page 93 and 94: Continuous fetal monitoring should
Page 95 and 96: C use steroid tablets as normal whe
Page 97 and 98: 7.9.2 AT-RISK POPULATIONS Several h
Page 99 and 100: 7.9.6 SPECIFIC BRONCHIAL PROvOCATIO
Page 101 and 102: Asthma clinics in primary care may
Page 103 and 104: A 8.3 Audit discharge from hospital
Page 105 and 106: 9 Patient education and self manage
Page 107 and 108: 9.2.1 COMPLIANCE WITH MONITORING AN
Page 109 and 110: Table 15. Summary of the key compon
Page 111: 8. What role does patient preferenc
Page 115 and 116: INHALER DEvICES Dr John White (Chai
Page 117 and 118: 11.4 disseMinAtion GrouP Mrs Sheila
Page 119 and 120: Abbreviations ABG arterial blood ga
Page 121 and 122: Annex 2 Management of acute severe
Page 123 and 124: Annex 4 Features of acute severe as
Page 125 and 126: Annex 6 Consider prednisolone 20 mg
Page 127 and 128: Annex 8 Management of acute asthma
Page 129 and 130: Annex 10 PEF (l/min) EU Scale 680 6
Page 131 and 132: Annex 11 (contd) Annexes 125
Page 133 and 134: 56. Abu-Hasan M, Tannous B, Weinber
Page 135 and 136: 156. Lodrup Carlsen KC, Carlsen KH,
Page 137 and 138: 256. Malmstrom M, Ahlner J, Carlsso
Page 139 and 140: 352. Brocklebank D, Ram F, Wright J
Page 141 and 142: 456. McDowell KM, Chatburn RL, Myer
Page 143 and 144: 562. McDonald JC, Keynes HL, Meredi
Page 145 and 146: 668. Enright PL, McClelland RL, New
Page 147 and 148: 767. Berger W. Budesonide inhalatio
Page 149 and 150: 862. Pedroletti C, Lundahl J, Alvin
Page 151: ISBN 978 1 905813 28 5 British Thor
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