Asthma: diagnosis, monitoring and chronic asthma management

This guideline covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks.

This is a new collaborative guideline developed jointly by the British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN).

We reviewed the evidence and made new or updated recommendations on diagnosis, treatment and monitoring. We also updated some recommendations without an evidence review. For full details see update information.

It updates and replaces NICE guideline 80 (published November 2017) and parts of BTS/SIGN British guideline SIGN 158 (published July 2019). It also updates and replaces NICE technology appraisal guidance 10, 38, 131 and 138, and NICE diagnostics guidance 12.

Next review: This guidance will be reviewed if there is new evidence that is likely to change the recommendations.

BTS, NICE and SIGN have developed an asthma pathway, which brings together recommendations on diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It also covers managing difficult and severe asthma and acute asthma attacks.

Recommendations

This guideline includes recommendations on:

• initial assessment
• objective tests for diagnosing asthma and diagnosing asthma in children under 5
• diagnosing occupational asthma
• monitoring asthma control
• pharmacological treatment including, treatment for people aged 12 and over, children aged 5 to 11 and children under 5
• decreasing maintenance therapy
• asthma in pregnancy and breastfeeding
• asthma in adolescents
• adherence and self-management
• risk-stratified care
• organisation and delivery of care

Who is it for?

• Healthcare professionals in primary care and the community, secondary care and tertiary asthma services
• Commissioners and providers
• People with suspected or diagnosed asthma, their families and carers