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35min module
Asthma Guidelines
with June Roberts
This module provides an overview of key asthma guidelines, including:
- global and local guidelines including GINA, BTS/SIGN,
- key recommendations and updates, and
- an overview of the NICE quality and outcomes framework
No advice given in this module is intended to be a substitute for your own professional judgment in the clinical management of your patients.
Let's get started
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What should be included in a structured clinical history when asthma is suspected?
Reported wheeze, noisy breathing, cough, breathlessness or chest tightness, any variation in these symptoms and triggers that make symptoms worse
A personal or family history of asthma or allergic rhinitis
Symptoms that might suggest an alternate diagnosis
All of the above
Correct!
All of the above. A structured clinical history should explore common symptoms of asthma such as wheeze, noisy breathing, cough, breathlessness or chest tightness, variation in symptoms and any potential trigger factors. A personal or family history of asthma or allergic disease should also be included. It is equally important to explore any symptoms that might suggest an alternate diagnosis.
Incorrect
Not quite. A structured clinical history should comprehensively assess common asthma symptoms such as wheeze, noisy breathing, cough, breathlessness, or chest tightness, including variation in these symptoms over time and potential trigger factors that worsen them, while also exploring any symptoms that might suggest an alternative diagnosis; in addition, it is important to include a personal or family history of asthma, allergic rhinitis, or other allergic disease, as this forms a key part of the overall clinical assessment.
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Before initiating a new drug therapy clinicians should check the patients:
Adherence with existing therapies, inhaler technique and how they manage trigger factors
Inhaler technique, FeNO, trigger factors
Smoking status, occupational exposures and inhaler technique
Adherence with existing therapies, inhaler technique, FeNO level
Correct!
That’s right. Explore and try to address the possible key reasons for uncontrolled asthma before starting or adjusting medicines for asthma in adults, young people and children.
Incorrect
Almost! As part of the assessment, checking inhaler technique, FeNO levels, smoking status, and occupational exposures should be considered; however, it is vital to explore the patient’s adherence to existing therapies in depth to uncover possible reasons for uncontrolled asthma, as raised FeNO levels may suggest poor adherence, and to understand how the patient recognises and manages trigger factors that may contribute to poor asthma control.
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What factors should be considered when selecting an inhaler device?
An assessment of correct inhaler technique, clinician preference, environmental impact
An assessment of correct inhaler technique, patient preference, environmental impact
Patient preference, environmental impact, local prescribing guidelines
Patient preference, assessment of correct inhaler technique, clinician preference
Correct!
That’s right. Poor inhaler technique is a major contributor to poor asthma control so assessment of the patient’s technique is critical. Patient preference is important too as people are more likely to take treatment if they are comfortable with the device chosen. The environmental impact of inhalers should also be considered in line with NHS targets to reduce its carbon footprint.
Incorrect
Not quite. Poor inhaler technique is a major contributor to poor asthma control, so assessment of the patient’s technique is critical. Inhaler choice should be guided by patient preference to support adherence, and the environmental impact of inhalers should be considered in line with NHS targets and local prescribing guidelines.
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How is difficult asthma defined?
Patients have a prior diagnosis of asthma and asthma-like symptoms, high levels of reliever use and anxiety
Patients have asthma-like symptoms and asthma attacks persist with high use of reliever medication
Patients have high levels of anxiety, asthma attacks and high use of reliever medication
Patients have a prior diagnosis, and asthma-like symptoms and asthma attacks persist despite prescription of high-dose asthma therapy
Correct!
That’s right. Patients with difficult asthma should be systematically reviewed to confirm the diagnosis and to explore the reasons for persisting symptoms. This should include assessment of adherence to therapy, inhaler technique and exploration of trigger factors.
Incorrect
Whilst many patients with difficult asthma will have high reliever use and some will have psychological impacts such as anxiety the actual definition of difficult asthma is a prior diagnosis and asthma-like symptoms and asthma attacks that persist despite prescription of high dose asthma therapy. Patients with difficult asthma should be systematically reviewed to confirm the diagnosis and to explore the reasons for persisting symptoms. This should include assessment of adherence to therapy, inhaler technique and exploration of trigger factors.
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According to NICE Quality and Outcomes Framework Asthma indicators April 2025, what should be included in an annual asthma review?
An assessment of asthma control using a validated asthma control questionnaire, a recording of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan
Review of written personalised asthma action plan, assessment of inhaler technique, review of diagnosis and trigger factors
Review of asthma control, assessment of inhaler technique and a written personalised action plan
Recording of number of exacerbations and assessment of inhaler technique
Correct!
Correct! That’s right. It’s important to use a validated asthma control test such as Asthma Control Test (ACT) or Asthma Control Questionnaire (ACQ) as these have an evidence base for objectively identifying poor asthma control. Likewise, the number of exacerbations can indicate poor asthma control and increased risk of hospitalisation and death from asthma. Inadequate inhaler technique may be an underlying reason for poor control and lack of personalised action plans is also known to contribute to worse patient outcomes.
Incorrect
Poor asthma control should prompt a review of the diagnosis and trigger factors, but annual asthma reviews should also include a validated asthma control test, such as the Asthma Control Test (ACT) or Asthma Control Questionnaire (ACQ), as these are evidence-based tools for objectively identifying poor control. It is equally important to review the number of exacerbations, as these indicate poor asthma control and an increased risk of hospitalisation and death from asthma. Assessment of inhaler technique is essential, as inadequate technique may underlie poor control, and patients should be provided with a written personalised action plan, as the absence of such plans is known to contribute to worse patient outcomes.
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