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KEY TO EVIDENCE STATEMENTS AND GRADES OF RECOMMENDATIONS LEVELS OF EVIDENCE 1 ++ High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 - Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2 ++ High quality systematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal 2 - Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3 Non-analytic studies, eg case reports, case series 4 Expert opinion GRADES OF RECOMMENDATION Note: The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation. A B C D At least one meta-analysis, systematic review, or RCT rated as 1 ++ , and directly applicable to the target population; or A body of evidence consisting principally of studies rated as 1 + , directly applicable to the target population, and demonstrating overall consistency of results A body of evidence including studies rated as 2 ++ , directly applicable to the target population, and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 1 ++ or 1 + A body of evidence including studies rated as 2 + , directly applicable to the target population and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 2 ++ Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2 + GOOD PRACTICE POINTS � Recommended best practice based on the clinical experience of the guideline development group � Audit point NHS Evidence has accredited the process used by the Scottish Intercollegiate Guidelines Network and the British Thoracic Society to co-produce the British guideline on the management of asthma. Accreditation is valid for 5 years from January 2012 and is retrospectively applicable from May 2011. More information on accreditation can be found at www.evidence.nhs.uk. Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. SIGN guidelines are produced using a standard methodology that has been equality impact assessed to ensure that these equality aims are addressed in every guideline. This methodology is set out in the current version of SIGN 50, our guideline manual, which can be found at www.sign.ac.uk/guidelines/fulltext/50/index.html. The EQIA assessment of the manual can be seen at www. sign.ac.uk/pdf/sign50eqia.pdf. The full report in paper form and/or alternative format is available on request from the Healthcare Improvement Scotland Equality and Diversity Officer. Every care is taken to ensure that this publication is correct in every detail at the time of publication. However, in the event of errors or omissions corrections will be published in the web version of this document, which is the definitive version at all times. This version can be found on our web site www.sign.ac.uk. This document is produced from elemental chlorine-free material and is sourced from sustainable forests.
British Thoracic Society Scottish Intercollegiate Guidelines Network British Guideline on the Management of Asthma A national clinical guideline The College of Emergency Medicine May 2008 Revised January 2012
Page 1: 101 British Guideline on the Manage
Page 5 and 6: Revised 2011 Revised 2011 Revised 2
Page 7 and 8: 1 introduction 1.1 the need for A G
Page 9 and 10: 1.3.1 PATIENT vERSION Patient versi
Page 11 and 12: Table 1: Clinical features that inc
Page 13 and 14: Case detection studies have used sy
Page 15 and 16: 2.1.6 CHILDREN WITH AN INTERMEDIATE
Page 17 and 18: 2.3 suMMAry focus the initial asses
Page 19 and 20: 2.4 diAGnosis in Adults The diagnos
Page 21 and 22: 2.4.1 FURTHER INvESTIGATION OF PATI
Page 23 and 24: Table 6: Differential diagnosis of
Page 25 and 26: 2.5.1 TREATMENT TRIALS AND REvERSIB
Page 27 and 28: A small prospective observational s
Page 29 and 30: Table 8: Summary of tools that can
Page 31 and 32: Measurement Methodology Asthma Cont
Page 33 and 34: Measurement Methodology Eosinophil
Page 35 and 36: 3.1.2 FOOD ALLERGEN AvOIDANCE Sensi
Page 37 and 38: The limited data on antenatal or ea
Page 39 and 40: 3.3.2 AIR POLLUTION Challenge studi
Page 41 and 42: 3.5 CoMPleMentAry And AlternAtive M
Page 43 and 44: Revised 2011 4 Pharmacological mana
Page 45 and 46: Table 8b: Equivalent doses of inhal
Page 47 and 48: 4.2.3 SAFETy OF INHALED STEROIDS Th
Page 49 and 50: 4.3.2 ADD-ON THERAPy Options for ad
Page 51 and 52: 4.4 steP 4: Poor Control on ModerAt
Page 53 and 54:
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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5.3 inhAled steroids for stABle Ast
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Revised 2009 6 Management of acute
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Patients with brittle or difficult
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Table 11: Initial assessment - the
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In acute asthma without life threat
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6.3.8 ANTIBIOTICS 6.3.9 HELIOx When
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6.6.2 PATIENT EDUCATION Following d
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6.7.2 PULSE OxIMETRy 6.7.3 PEF Accu
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Frequent doses up to every 20-30 mi
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6.9.3 Iv MAGNESIUM SULPHATE Intrave
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New 2011 7 special situations 7.1 A
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Gender During adolescence there is
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Complementary and alternative medic
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Table 13: Recommendations for organ
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7.2 diffiCult AsthMA 7.2.1 DEFINING
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Revised 2009 Controlled studies usi
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Continuous fetal monitoring should
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C use steroid tablets as normal whe
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7.9.2 AT-RISK POPULATIONS Several h
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7.9.6 SPECIFIC BRONCHIAL PROvOCATIO
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Asthma clinics in primary care may
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A 8.3 Audit discharge from hospital
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9 Patient education and self manage
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9.2.1 COMPLIANCE WITH MONITORING AN
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Table 15. Summary of the key compon
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8. What role does patient preferenc
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Dr James Paton* Reader and Honorary
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INHALER DEvICES Dr John White (Chai
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11.4 disseMinAtion GrouP Mrs Sheila
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Abbreviations ABG arterial blood ga
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Annex 2 Management of acute severe
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Annex 4 Features of acute severe as
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Annex 6 Consider prednisolone 20 mg
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Annex 8 Management of acute asthma
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Annex 10 PEF (l/min) EU Scale 680 6
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Annex 11 (contd) Annexes 125
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56. Abu-Hasan M, Tannous B, Weinber
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156. Lodrup Carlsen KC, Carlsen KH,
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256. Malmstrom M, Ahlner J, Carlsso
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352. Brocklebank D, Ram F, Wright J
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456. McDowell KM, Chatburn RL, Myer
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562. McDonald JC, Keynes HL, Meredi
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668. Enright PL, McClelland RL, New
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767. Berger W. Budesonide inhalatio
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862. Pedroletti C, Lundahl J, Alvin
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ISBN 978 1 905813 28 5 British Thor
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