The diagnosis and management of asthma is complicated by many factors. Objective investigations are key in ensuring an accurate diagnosis but are not available in all healthcare settings. Poor concordance with medication is common. Co-morbidity causing breathlessness is common and may complicate asthma. The main guidelines for asthma all differ slightly in their approach.
Originally published in August 2020, the All Wales asthma guideline aimed to improve asthma outcomes and reduce variation in inhaler prescribing in the management of adult asthma. It was based on recommendations from the British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Global Initiative for Asthma (GINA).
The 2021 update encouraged consideration of the NHS Wales decarbonisation agenda. The 2024 update follows the Global Initiative for Asthma approach in recommending anti-inflammatory reliever therapy as the preferred regimen for managing mild-moderate asthma. In the Spring of 2023 ICS/ formoterol was approved as a reliever therapy in addition to its pre-existing licence as a preventer or MART therapy. This has allowed the development of the All Wales guidelines which when implemented should improve asthma care; reducing reliance on short acting bronchodilators, reducing the risk of asthma exacerbations and improving the respiratory carbon footprint of the NHS. This approach has been endorsed by the primary care respiratory society (PCRS). In the UK this new therapy has not yet been incorporated in national guidelines with the joint British Thoracic Society/ NICE guidelines currently being under development.
Core principles:
