Evidence Based Clinical Practice Guideline

The primary care management of asthma in adults

North of England Evidence Based Guideline Development Project

Centre for Health Services Research University of Newcastle upon Tyne

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Preface

This guideline was developed over a period of 18 months in 1994/5. The group members committed both time and enthusiasm to the task and I am immensely grateful to them for this. Guidelines evoke differing responses from different people; if I were to have any influence on how this guideline was viewed I would wish it to be viewed in the following way:

"Medical practitioners should regard this guideline as a useful reference tool: not the rulings of philosopher kings, but the attempt of thoughtful people to share their knowledge - albeit imperfect - with other people."

Adapted from Tong, R. (1991) The epistemology and ethics of consensus: uses and misuses of "ethical" expertise. Journal of Medicine and Philosophy 16: 409-426.

Martin Eccles

Acknowledgements

We are very grateful to Liz Wood for her skilled secretarial work on the guideline and to Carol Riccalton for proof reading it.

CONTENTS

• Summary
• Methods
  • Aim of the Guideline
  • Responsibility and support for guideline development
  • Guideline development group
  • Evidence identification, review and synthesis
  • External review of the guideline
  • Piloting/pre-testing of the guideline
  • Scheduled review of the guideline
• Introduction
• Guideline
  • Scope of the guideline
  • Peak flow: diagnosis and management
  • Aims of treatment
  • Drug treatment
    • Compliance
    • Short acting beta2 agonists
    • Long acting beta2 agonists
    • Inhaled anti-inflammatory agents
      • Inhaled steroids
      • Differing steroid preparations
      • Addition of inhaled steroids to short acting beta2 agonists
      • Dose of inhaled steroids
      • Decreasing steroid dosage
      • Other inhaled anti-inflammatory agents
    • Drug delivery devices
    • Inhaler technique
    • Oral bronchodilators
    • Oral steroids
    • Intravenous therapy in acute asthma
  • Drug sequencing
    • Chronic asthma: sequencing drugs
    • Chronic asthma: sequencing drug delivery devices
    • Uncontrolled asthma sequencing drugs
  • Non-drug treatment
    • Acupuncture
    • Yoga
  • Precipitants
    • Allergen avoidance
    • Smoking and smoking cessation
  • Patient education
  • Referral
    • Referral to a chest physician
• Appendix 1: MEDLINE search strategy
• Appendix 2: Criteria against which the literature were assessed
• Appendix 3: Instructions for reviewers