Updating guidelines on asthma in adults

Evidence based guidelines are being updated—as they should be

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 …