Intended for healthcare professionals


Conflicting asthma guidelines cause confusion in primary care

BMJ 2018; 360 doi: (Published 09 January 2018) Cite this as: BMJ 2018;360:k29
  1. Duncan Keeley, executive committee policy lead1,
  2. Noel Baxter, chair1
  1. 1Primary Care Respiratory Society UK, Solihull, UK
  1. Correspondence to: D Keeley duncan.keeley{at}

A way forward for clinicians while we streamline the guideline process

Asthma is a common and potentially serious chronic condition that continues to cause avoidable morbidity and mortality.1 The majority of asthma management takes place in primary care.

Since 1992 asthma guidelines from the British Thoracic Society (BTS), now under the auspices of the Scottish Intercollegiate Guideline Network (SIGN), have been widely accepted and used in the United Kingdom.2 With the recent publication of a guideline by the National Institute for Health and Care Excellence (NICE) 3 we now have substantially conflicting advice on key issues in asthma diagnosis and management. Differing conclusions have been reached by looking at very similar evidence. Why has this happened and what are primary care professionals to do?

In 2013 it was decided that NICE would produce guidelines for diagnosis and monitoring of asthma, and later for the management of chronic (but not acute) asthma. Reasons included a wish to incorporate cost effectiveness analyses—which the BTS/SIGN guideline does not consider—and concerns about overdiagnosis, overtreatment, and consequent waste of resources.

From the outset …

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