National Institute for Health and Clinical Excellence (NICE)
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NICE consults on draft guideline to improve asthma diagnosis

Roughly 1.2 million adults in the UK may be wrongly receiving treatment for asthma [1].

The National Institute for Health and Care Excellence (NICE) has issued a draft guideline to set out the most effective way to diagnose asthma and how healthcare professionals can help adults, children and young people better control their symptoms2.

Asthma occurs when a person encounters something that irritates their lungs and causes the small airways to become inflamed and narrow, making it difficult to breathe. Symptoms include breathlessness, coughing, wheezing and tightness in the chest.

Professor Mark Baker, director of clinical practice at NICE said: “Asthma is a long-term incurable condition that affects millions of people of all ages. If left untreated asthma attacks can be life threatening. However, with appropriate treatment and thoughtful monitoring, most people will be able to successfully control their symptoms and be spared from serious harm. Accurate diagnosis of asthma has been a significant problem which means that people may be wrongly diagnosed or cases might be missed in others. Our aim with this guideline is to give clarity and set out the most clinical and cost effective ways to diagnose and monitor asthma based on the best available evidence.”

There is currently no gold standard test to diagnose asthma and in current practice healthcare professionals mainly check for signs and symptoms. However, with almost a third (30%) of people being treated for asthma no longer showing signs of the condition, appropriate diagnosis requires supportive tests.

The guideline, published for consultation, stresses that to achieve an accurate diagnosis clinical tests should be used as well as checking for signs and symptoms. The process which the healthcare professional should follow in the initial assessment, and the tests to use, are presented in simple flow charts.

The first test should be carried out using a spirometer, a machine which measures how much and how fast you breathe out. Further breath tests should be carried out depending on the results from spirometry and the patient’s age.

For adults and young people over 5 years, tests include checking for levels of nitric oxide, a gas which is found in larger volumes in people with asthma (FeNO test3), and whether standard medicines which widen the airways of the lung are of benefit (BDR test4). The treatment of under-5s should be based on professional judgement and observation until the child is old enough to take clinical tests.

Around 1 in 10 of adults with asthma develops the condition because they are exposed to certain substances, such as chemicals or dust, in their workplace5. The draft guideline also recommends that healthcare professionals should ask employed people how their symptoms are affected by work to check if they may have occupational asthma.

Other key priorities include recommendations for monitoring how well a patient is controlling their symptoms. The draft guideline states that during each review healthcare professionals should check that the patient is able to use their inhaler correctly and also consider using a validated questionnaire6 so they get a better estimate of how well a person is doing.

Professor Baker added“This new draft guideline provides advice for primary, secondary and community care healthcare professionals on the most suitable tests for accurately diagnosing asthma and how to help people monitor and control their symptoms. We now want to hear from all those who provide care for people with asthma in the NHS to ensure all relevant views are considered for the final guideline.”

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

Further information

  1. Over 4.1 million people in the UK are currently receiving treatment for asthma, studies show that almost a third (30%) of adults with the condition do not have clear evidence of asthma. Some may have had asthma in the past, but it is likely that many have been given an incorrect diagnosis.
  2. The draft guidance for ‘diagnosis and monitoring of asthma in adults, children and young people’ is available at /guidance/indevelopment/GID-CGWAVE0640. The public consultation on the draft guideline will be open until Wednesday 11 March.
  3. A fractional exhaled nitric oxide (FeNO) test measures the amount of nitric oxide present when a person breathes out. Patients with asthma have higher nitric oxide levels than other people.
  4. A bronchodilator reversibility (BDR) test measures the ability to reverse an obstruction in the airways using drugs that widen the airways (bronchodilators). People with asthma will have their symptoms improve after treatment with bronchodilators.
  5. Occupational asthma may account for between 9 and 15% of adult onset asthma. It is the commonest industrial lung disease in the developed world with over 400 reported causes.
  6. A validated questionnaire such as the Asthma Control Questionnaire or Asthma Control Test.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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