I was interested to read Dr Hilary Pinnock's article 'British guideline updates advice on inhaled steroids in mild asthma,' (Guidelines in Practice May 2004) on the recently updated SIGN/British Thoracic Society guideline on the management of asthma.

The original guideline was published only last year. Yet along with the revised edition, available on the SIGN and BTS websites, comes the promise of further annual electronic updates, with the guideline continually evolving to reflect new research findings. This approach has to be welcomed and must be the way forward for all clinical guidelines.

The changes to the guideline are subtle but nevertheless very helpful, clarifying some important clinical issues. Perhaps the most significant relate to the earlier introduction of inhaled steroids in milder asthma and how suboptimally treated individuals can be identified.

When I am teaching medical students in asthma management I encourage them to look at the patient's recent symptomatic history to help make a judgement about adequacy of control. The guideline backs this approach and sets some new markers, such as the frequency of symptoms, beta-agonist use and exacerbations. Perhaps clinical computer software suppliers will pick up on this and modify asthma review templates to record such information.

The new GMS contract has identified asthma as an important clinical domain, with regular reviews being tied to quality points.This structured care is supported and extended in the guideline. However,GPs are invited to go further and consider issues such as the provision of treatment action plans and patient education.

The guideline also recognises the importance of education of health professionals. Individual GPs and those responsible for educational provision should take note of the evidence that better training improves care and outcomes.

Dr Peter Saul, GP,Wrexham,
and hospital practitioner paediatrics (asthma and allergy),
Countess of Chester Hospital

Guidelines in Practice, July 2004, Volume 7(7)
© 2004 MGP Ltd
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