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1 introduction
1.1 the need for A Guideline
Asthma is a common condition which produces a significant workload for general practice,
hospital outpatient clinics and inpatient admissions. It is clear that much of this morbidity relates
to poor management particularly the under use of preventative medicine.
In 1999 the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network
(SIGN) agreed to jointly produce a comprehensive new asthma guideline, both having previously
published guidance on asthma. The original BTS guideline dated back to 1990 and the SIGN
guidelines to 1996. Both organisations recognised the need to develop the new guideline using
explicitly evidence based methodology. The joint process was further strengthened by collaboration
with Asthma UK, the Royal College of Physicians of London, the Royal College of Paediatrics and
Child Health, the General Practice Airways Group (now Primary Care Respiratory Society UK),
and the British Association of Accident and Emergency Medicine (now the College of Emergency
Medicine). The outcome of these efforts was the British Guideline on the Management of Asthma
published in 2003. 1
The 2003 guideline was developed using SIGN methodology. 2 Electronic literature searches
extended to 1995, although some sections required searches back as far as 1966. The
pharmacological management section utilised the North of England Asthma guideline to address
some of the key questions on adult management. 3 The North of England guideline literature search
covered a period from 1984 to December 1997, and SIGN augmented this with a search from
1997 onwards.
1.1.1 UPDATING THE EvIDENCE
Since 2003 sections within the guideline have been updated annually and posted on both the
BTS (www.brit-thoracic.org.uk) and SIGN (www.sign.ac.uk) websites.
The timescale of the literature search for each section is given in Annex 1. It is hoped that this
asthma guideline continues to serve as a basis for high quality management of both acute and
chronic asthma and a stimulus for research into areas of management for which there is little
evidence. Sections of the guideline will continue to be updated on the BTS and SIGN websites
on an annual basis.
1.2 reMit of the Guideline
1.2.1 OvERALL OBJECTIvES
This guideline provides recommendations based on current evidence for best practice in
the management of asthma. It makes recommendations on management of adults, including
pregnant women, adolescents, and children with asthma. In sections 4 and 5 on pharmacological
management and inhaler devices respectively, each recommendation has been graded and the
supporting evidence assessed for adults and adolescents over 12 years old, children 5-12 years,
and children under 5 years. In section 7.1 recommendations are made on managing asthma in
adolescents (10-19 years of ages as defined by the World Health Organisation (WHO). 864
The guideline considers asthma management in all patients with a diagnosis of asthma irrespective
of age or gender (although there is less available evidence for people at either age extreme). The
guideline does not cover patients whose primary diagnosis is not asthma, for example those with
chronic obstructive pulmonary disease or cystic fibrosis, but patients with these conditions can
also have asthma. Under these circumstances many of the principles set out this guideline will
apply to the management of their asthma symptoms.
The key questions on which the guideline is based can be found on the SIGN website,
www.sign.ac.uk, as part of the supporting material for this guideline.
introduCtion
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