Originally published in August 2020, this guideline aims to reduce variation in inhaler prescribing in the management of adult asthma. In 2021, this guideline was updated to encourage consideration of the decarbonisation agenda of NHS Wales.
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be treated with an inhaled corticosteroid and the practice of using short acting bronchodilator monotherapy is now outdated.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 2024, the guideline was further updated to include a new ‘preferred regimen’ for mild asthma, and the option to use some asthma medicines in an unlicensed manner was added (with links to relevant guidance on unlicensed medicines incorporated). These updates were to bring the guidance in line with other nationally recognised recommendations. The National Institute for Care Excellence and the British Thoracic Society are planning to publish asthma guidance in 2024. This All Wales guideline will be reviewed in the light of the publication of that document.