New tests for diagnosis can improve asthma care, says NICE

New guidance from NICE – the National Institute for Health and Care Excellence – is intended to set out "clear and effective" ways to diagnose, monitor and help people take control of their asthma.

The guideline makes new recommendations on the use of objective diagnostic testing for asthma and the use of medicines to manage the condition in those diagnosed.

NICE is recommending objective testing including spirometry and FeNO tests alongside clinical assessment to help diagnose asthma in primary care. These tests will help to achieve more accurate diagnosis and therefore more effective treatment.

In current practice healthcare professionals mainly check for signs and symptoms. However, some people later sometimes show no signs of the condition.

Professor Mark Baker, director of the centre for guidelines at NICE, said:

“We are recommending objective testing with spirometry and FeNO for most people with suspected asthma; a significant enhancement to current practice, which will take the NHS some time to implement, with additional infrastructure and training needed in primary care. 

“New models of care, being developed locally, could offer the opportunity to implement these recommendations. This may involve establishing diagnostic hubs to make testing efficient and affordable. They will be able to draw on the positive experience of NICE’s primary care pilot sites, which trialled the use of FeNO.

“The investment and training required to implement the new guidance will take time. In the meantime, primary care services should implement what they can of the new guidelines, using currently available approaches to diagnosis until the infrastructure for objective testing is in place.”

NICE estimates that the NHS could save between £10 and 15 million over a five year period depending on how diagnostic hubs are established, mainly through reducing unnecessary prescriptions.

Dr Andrew Menzies-Gow, consultant in respiratory medicine at the Royal Brompton and Harefield NHS Foundation Trust and co-chair of the guideline committee, said: “There is no ‘gold standard’ test that can give a definitive diagnosis. This can lead to people having treatments they may not need, or to a missed diagnosis in people who do have asthma.

“Our recommendations will help tackle inappropriate diagnosis and ensure that if a diagnosis is given, that the person is monitored to ensure their symptoms still indicate asthma.”


The recommendations on managing asthma says many people gain good control of their symptoms using a ‘brown or orange’ preventer inhaler regularly.

In those who need more treatment, current practice is to offer people a long acting beta-agonist (LABA) with a low-dose inhaled corticosteroid. This can be provided in a combination inhaler, which people often refer to by their colour (pink, red, yellow, purple or grey), or in two separate devices.

NICE now recommends these people are offered a leukotriene receptor antagonist (LTRA) tablet with a preventer inhaler before they are given LABA treatment.

This could save the NHS an estimated £2 million a year for every 10,000 people who take up the new recommendation, NICE says.

LTRAs are significantly more cost effective for the NHS due to their lower price.

Dr John Alexander, consultant in paediatric intensive care at University Hospitals of North Midlands NHS Trust and co-chair of the guideline committee, said: “There is no cure for asthma, so our focus must be on helping people manage and take control of their symptoms. This guideline sets out the most effective options to treat asthma to make patients feel better and potentially save the NHS money.”

According to Asthma UK, around 4.5 million people in England are receiving treatment for asthma.


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