Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE

The British Thoracic Society (BTS) first produced a guideline on asthma and its management in 1990. The first collaborative guideline with the Scottish Intercollegiate Guideline Network (SIGN) using evidence-based medicine methodology was published in 2003.1 It has since become a mainstay of asthma management across the UK and beyond with updates published regularly every 18–24 months. The latest BTS/SIGN guideline for the management of asthma was published in 2016.2 Both BTS and SIGN are committed to continuing updates with the next update planned for publication in 2019. Following publication of National Institute for Health and Care Excellence (NICE) guidelines for diagnosis and monitoring, and for management of chronic asthma,3–5 there are now two if not three national guidelines, for England at least, with some (apparently) striking differences. This statement considers the similarities and differences to assist clinical colleagues in the care of people with asthma. The evidence base considered by the BTS/SIGN and NICE guideline development groups is broadly the same for each guideline, but the methodology used to produce recommendations is significantly different: These different processes have resulted in some discrepancies in recommendations made by BTS/SIGN and NICE. This article seeks to provide some context to these differences in key areas: The BTS/SIGN guideline also provides recommendations …