The familiar stepwise approach to management of asthma is unchanged from previous versions. However, the new 2008 guideline contains:
The new guidance also states that:
In adult patients at step 3 who are poorly controlled, the use of budesonide/ formoterol in a single inhaler as rescue medication instead of a short-acting beta2 agonist, in addition to its regular use as a controller treatment, is an effective treatment option. Before instituting this management careful patient education is required.
It is important to note that the guidance says this is an option for patients at step 3 who are poorly controlled. This refers to patients who have already moved from step 2 to step 3 (ie they have previously needed to move from regular inhaled steroid alone to regular inhaled steroid plus regular long-acting beta2 agonist [LABA]), and whose asthma is uncontrolled with this regime, as an alternative to moving to step 4. Note also that not all patients respond to LABAs, in which case an alternative approach is required (see the guideline).
Regular review of patients, and stepping down, is essential. Before adding or changing treatment practitioners should check compliance with existing therapy, check the patient’s inhaler technique and eliminate trigger factors. Most patients can be managed successfully at step 2 (regular inhaled steroid plus reliever inhaler when required), at least most of the time.
SIGN and BTS have made a joint statement about certain drug advertisements. They say that it has come to their attention that a number of advertisements have appeared in the medical press which could, erroneously, imply to clinicians that the new asthma guideline has recommended, or endorsed, specific (named) pharmaceutical products. Moreover, these advertisements do not accurately summarise the guideline in the way they purport to do. BTS and SIGN stress that the new asthma guideline does not recommend any specific products.
Update 7/10/08 – this statement has now been removed from the BTS/SIGN website.