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New NICE guidelines on Asthma diagnosis and monitoring in primary care
26 June 2015


The way clinicians are to diagnose and manage cases of asthma is changing. New guidelines drafted by NICE in January are expected to be fully published in August. According to NICE, the new guidelines are needed as there is evidence to suggest that incorrect diagnosis is a significant problem.

NICE advisers said that studies have shown that up to 30% of people do not have clear evidence of asthma and while some may previously have suffered it, many patients will have been wrongly diagnosed as asthmatic.


Why the change?

Despite there being a number of methods & assessments currently used in today's practice, there is still no gold standard to accurately diagnose asthma in patients. According to NICE, "These latest guidelines aim to determine the most clinical and cost effective way to effectively diagnose people with asthma and determine the most effective monitoring strategy to ensure optimum asthma control."

What is changing?

In conjunction with performing Spirometry, NICE are recommending that a fractional exhaled nitric oxide (FeNO) test is performed. A FeNO monitor detects levels of nitric oxide in the breath. People with asthma are known to have higher levels of this in their airways.


NICE asthma diagnosis guidelines (draft) – key recommendations


Diagnosing asthma: objective tests in adults and children over five

Use spirometry as the first-line investigation in adults and children over the age of five

- FEV1/FVC less than 70% indicates obstructive spirometry

Next offer a bronchodilator reversibility (BDR) test to anyone with obstructive spirometry. Positive BDR result indicated by:

- Improvement in FEV1 of 12% or more, in children aged 5-16

- Improvement in FEV1 of 12% or more plus increase in volume of 200ml or more, in older patients

Offer a FeNO test in adults and young people older than 16 if considering a diagnosis of asthma

- FeNO of 40 ppb or more indicates positive test

Offer a direct bronchial challenge test with histamine or methacholine in adults and young people older than 16 if there is diagnostic uncertainty after a normal spirometry and either:

- FeNO level of 40 ppb or more and no variability in peak flow readings or

- FeNO level of 39 ppb or less with variability in peak flow readings


Diagnosing asthma in under-fives

Treat symptoms based on observation and clinical judgement in children younger than five years. If asthma still suspected, when the child is old enough to take part in objective tests (usually around the age of five), perform these and review the diagnosis



How do I become compliant with the new guidelines?

bedfontNObreath-Intermedical.jpgAlthough the guidelines are currently at a draft stage, your practice will need to purchase a FeNO monitor if you wish to comply when they are finally published.

The Bedfont NObreath is a monitor recommended by NICE.




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