The updated British Guideline on the Management of Asthma was published last week by the Scottish Intercollegiate Guidelines Network (SIGN) and the British Thoracic Society (BTS).
It emphasises the importance of accurate diagnosis and management of ‘difficult asthma’, a condition where exacerbations of asthma persist despite high-dose asthma therapy.
Sandra Dermott, asthma specialist nurse at Wrightington, Wigan and Leigh Hospitals NHS Trust, said:
‘Difficult asthma is not a straightforward condition and all sorts of things can trigger [an attack].
‘Patients with difficult asthma have a higher risk of death, and this section in the guidelines will be useful in helping healthcare professionals spot vulnerable patients who are not responding to treatment,’ she said.
The document also states that current UK practice on using a nebuliser to administer high doses of bronchodilators to A&E patients with acute exacerbation of asthma is often unnecessary, and it recommends using lower doses delivered via a spacer, which evidence shows is just
Jane Scullion, chairperson of the RCN respiratory nurse forum, said: ‘We have known this for quite a while, but a lot of A&Es still use nebulisers because of ease of use. This sends out the wrong message, however, and patients will want nebulisers because they believe they are stronger when they are not.
‘The focus has been on COPD a lot recently, but it is about time we refocused on asthma because the rates of morbidity and mortality are still very high,’ she added.
The updated guideline also includes recommendations on the use of written, personalised asthma action plans, pharmacological and non-pharmacological management, and diagnosing and treating occupational asthma.