Updating guidelines on asthma in adultsBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7326.1380 (Published 15 December 2001) Cite this as: BMJ 2001;323:1380
Evidence based guidelines are being updated—as they should be
- Brendan Delaney, reader in primary care and general practice (firstname.lastname@example.org)
- Department of Primary Care and General Practice, University of Birmingham Medical School, Birmingham B15 2TT
The changes to the North of England evidence based guidelines on managing asthma in adults in primary care are not very great (see updated guidelines on bmj.com), but they are important and illustrate the need to keep guidelines updated if they are to continue to be useful in guiding doctors' clinical practice.
The new guidelines draw on the reviews produced by the Cochrane airways collaborative review group1 since the first North of England guideline in 1996, as well as updating the literature searches and meta-analyses originally conducted by the group.2
The principal change in this useful updated guideline is the increasing role for long acting β2 agonists. These have replaced oral treatments as additional treatment when patients have nocturnal symptoms or need regular short acting β2 agonists in spite of inhaled steroids equivalent to beclomethasone 1000 μg daily. A recent Cochrane review of six trials comparing long acting β2 agonists with oral theophylline supports this recommendation.3 Patients taking salmeterol experienced fewer adverse events than those using theophylline …