This guideline aims to reduce variation in inhaler prescribing. Several audits in different health boards have demonstrated large variations in inhaler prescribing between different practices despite similar prevalence of asthma. Many health boards have produced local guidelines for asthma management, and it was discussed and agreed at Respiratory Health Implementation Group (RHIG) meetings that an All Wales guideline would be more effective than local plans.
Patients with asthma need to be managed according to their disease severity. All patients with asthma should be treated with an inhaled corticosteroid and the practice of using short acting bronchodilator monotherapy is now outdated. In those with well controlled symptoms appropriate management includes having their therapy stepped down. Given the evidence linking high inhaled steroid use to potentially severe adverse effects, over the past few years there has been a concerted effort to increase patient safety and reduce the dose of inhaled corticosteroids used by patients on a daily basis in controlling their asthma. As well as having a significant impact on patient safety this can also enable the achievement of cost efficiencies. This, in turn, can facilitate more timely access to novel, high-cost therapies (e.g. biological agents) in those with severe disease, thus optimising the treatment of all patients with asthma.
AWMSG has endorsed the guidance developed by RHIG as ‘Interim’ guidance pending the publication of NICE/BTS/SIGN guidance which we anticipate will be published in 2021.