British Guideline on the Management of Asthma

Douglas, Gordon C. C.; Higgins, Bernard; Barnes, Neil; Boyter, Anne; Burge, Sherwood; Cates, Chris; Connett, Gary; Couriel, Jon; Cullinan, Paul; Edwards, Sheila; Evans, E.O.; Fletcher, Monica; Griffiths, Chris; Heaney, Liam G.; Boon, Michele Hilton; Holmes, Steve; McArthur, Ruth; Nelson‐Piercy, C; Partridge, Martyn R; Paton, James Y.; Pavord, Ian D.; Carnegie, Elaine; Pinnock, Hilary; Qureshi, Safia; Robertson, Colin E.; Shields, Mike; Warner, John O.; White, John

doi:10.1136/thx.2008.097741

Cited by 641 publications

(122 citation statements)

References 1,032 publications

(598 reference statements)

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“…There is an extensive evidence base demonstrating that the provision of selfmanagement education supported by written action plans as part of regular asthma reviews improves outcomes. [65][66][67] Although this approach -known as 'guided self-management' -is endorsed by guidelines, [12][13][14]36 there is evidence of widespread underuse in clinical care. 68,69 Despite evidence from primary care studies, [70][71][72][73] there is a perception that such plans may not be appropriate for people with mild disease.…”

Section: Self-managementmentioning

confidence: 99%

“…Randomised trials suggest that inhaled corticosteroids (ICS) are the most efficacious 'controller', with no clinically relevant side effects at low to moderate doses. [12][13][14]36 Efficacy trials of alternative 'controllers' (e.g. anti-leukotrienes, LTRAs) in moderate asthma conclude that ICS produce better outcomes, though whether this is true for all patients with mild or intermittent asthma is debated.…”

Section: S5mentioning

confidence: 99%

“…[61][62][63][64] Although the management of acute asthma in different countries is dependent on resources and the organisation of care, a key skill for primary care in any healthcare setting is objective assessment of severity. [12][13][14]36 Most exacerbations seen in primary care are moderate, 61,63 but prompt recognition of life-threatening attacks, appropriate management, and close supervision of severe asthma may prevent deaths. …”

Section: Management Of Acute Asthmamentioning

confidence: 99%

“…To promote high quality care, international and national asthma guidelines are updated regularly [12][13][14] 15,16 though the paucity of evidence from patients managed in primary care is acknowledged. 14 By contrast, the IPCRG asthma guidelines aimed to highlight the special conditions in, and the evidence base from, primary care.…”

Section: Asthmamentioning

confidence: 99%

“…[38][39][40][41] Guidelines highlight the importance of developing a partnership between the doctor and the patient [12][13][14]36 so that regular professional review and monitoring of people with asthma is combined with appropriate treatment recommendations and selfmanagement education to enable patients to achieve treatment goals. 42 The dual concepts of asthma severity and asthma control have been widely discussed.…”

Section: Research Questionsmentioning

confidence: 99%

See 4 more Smart Citations

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

Pinnock

Thomas

Tsiligianni

et al. 2010

Primary Care Respiratory Journal

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Section: Self-managementmentioning

confidence: 99%

Section: S5mentioning

confidence: 99%

Section: Management Of Acute Asthmamentioning

confidence: 99%

Section: Asthmamentioning

confidence: 99%

Section: Research Questionsmentioning

confidence: 99%

See 3 more Smart Citations

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

Pinnock

Thomas

Tsiligianni

et al. 2010

Primary Care Respiratory Journal

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Association Between Evidence-Based Standardized Protocols in Emergency Departments With Childhood Asthma Outcomes

To²,

Parkin³

et al. 2012

Arch Pediatr Adolesc Med

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To determine whether children treated in emergency departments (EDs) with evidence-based standardized protocols (EBSPs) containing evidencebased content and format had lower risk of hospital admission or ED return visit and greater follow-up than children treated in EDs with no standardized protocols in Ontario, Canada. Design: Retrospective population-based cohort study of children with asthma. We used multivariable logistic regression to estimate risk of outcomes.

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Azithromycin for Acute Exacerbations of Asthma

et al. 2016

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IMPORTANCEGuidelines recommend against antibiotic use to treat asthma attacks. A study with telithromycin reported benefit, but adverse reactions limit its use.OBJECTIVE To determine whether azithromycin added to standard care for asthma attacks in adults results in clinical benefit. DESIGN, SETTING, AND PARTICIPANTSThe Azithromycin Against Placebo in Exacerbations of Asthma (AZALEA) randomized, double-blind, placebo-controlled clinical trial, a United Kingdom-based multicenter study in adults requesting emergency care for acute asthma exacerbations, ran from September 2011 to April 2014. Adults with a history of asthma for more than 6 months were recruited within 48 hours of presentation to medical care with an acute deterioration in asthma control requiring a course of oral and/or systemic corticosteroids.INTERVENTIONS Azithromycin 500 mg daily or matched placebo for 3 days. MAIN OUTCOMES AND MEASURESThe primary outcome was diary card symptom score 10 days after randomization, with a hypothesized treatment effect size of −0.3. Secondary outcomes were diary card symptom score, quality-of-life questionnaires, and lung function changes, all between exacerbation and day 10, and time to a 50% reduction in symptom score. RESULTSOf 4582 patients screened at 31 centers, 199 of a planned 380 were randomized within 48 hours of presentation. The major reason for nonrecruitment was receipt of antibiotics (2044 [44.6%] screened patients). Median time from presentation to drug administration was 22 hours (interquartile range, 14-28 hours). Exacerbation characteristics were well balanced across treatment arms and centers. The primary outcome asthma symptom scores were mean (SD), 4.14 (1.38) at exacerbation and 2.09 (1.71) at 10 days for the azithromycin group and 4.18 (1.48) and 2.20 (1.51) for the placebo group, respectively. Using multilevel modeling, there was no significant difference in symptom scores between azithromycin and placebo at day 10 (difference, −0.166; 95% CI, −0.670 to 0.337), nor on any day between exacerbation and day 10. No significant between-group differences were observed in quality-of-life questionnaires or lung function between exacerbation and day 10, or in time to 50% reduction in symptom score. CONCLUSIONS AND RELEVANCEIn this randomized population, azithromycin treatment resulted in no statistically or clinically significant benefit. For each patient randomized, more than 10 were excluded because they had already received antibiotics.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01444469

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British Guideline on the Management of Asthma

Cited by 641 publications

References 1,032 publications

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

Association Between Evidence-Based Standardized Protocols in Emergency Departments With Childhood Asthma Outcomes

Azithromycin for Acute Exacerbations of Asthma

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