All Wales adult asthma management and prescribing guideline

Originally published in August 2020, this guideline aims to reduce variation in inhaler prescribing in the management of adult asthma.

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be treated with an inhaled corticosteroid and the practice of using short acting bronchodilator monotherapy is now outdated.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, in recent 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.

In 2021, this guideline was updated to encourage consideration of the decarbonisation agenda of NHS Wales. This includes recommending the preferential prescribing of Dry Powder Inhalers (DPIs) rather than Metered Dose Inhalers (MDIs) due to the significantly reduced environmental impact associated with their use. This is aligned to the NHS Wales target of reducing the use of MDIs from more than 70% down to less than 20% by 2025 (see NHS Wales Decarbonisation Strategic Delivery Plan). Where appropriate, newly available inhaler options have also been incorporated.

(December 2021)