NICE guidance - inhaled corticosteroids (steroids) for the treatment of chronic asthma in adults and in children aged 12 years

• NICE state that:
  • for adults and children aged 12 years and older with chronic asthma in whom treatment with an inhaled corticosteroid (ICS) is considered appropriate, the least costly product that is suitable for an individual, within its marketing authorisation, is recommended
  • for adults and children aged 12 years and older with chronic asthma in whom treatment with an ICS and long-acting beta-2 agonist (LABA) is considered appropriate, the following apply.
    • use of a combination device within its marketing authorisation is recommended as an option
    • decision to use a combination device or the two agents in separate devices should be made on an individual basis, taking into consideration therapeutic need and the likelihood of treatment adherence
    • if a combination device is chosen then the least costly device that is suitable for the individual is recommended
• Use of inhaled corticosteroids in asthma
  • mild intermittent asthma (step 1) is treated with inhaled short-acting beta-2 agonists (SABAs), as required
  • introduction of regular preventer therapy with ICSs (step 2) should be considered when a person has had exacerbations of asthma in the previous 2 years, is using inhaled SABAs three times a week or more, is symptomatic three times a week or more, or is waking at night once a week because of asthma
  • add-on therapy (step 3) involves the introduction of an additional therapy, the first choice of which is an inhaled LABA
    • alternatives include orally administered leukotriene receptor antagonists, theophyllines and slow-release beta-2 agonist tablets, or increasing the dose of ICS
  • at step 4, further interventions may be considered if control remains inadequate on a dose of ICS that is equivalent to 800 micrograms per day of beclometasone dipropionate in combination with a LABA, or following an unsuccessful trial of a LABA
    • options include increasing the dose of the ICS to 2000 micrograms beclometasone dipropionate equivalent per day or adding a leukotriene antagonist, a theophylline or a slow-release beta-2 agonist tablet
  • at step 5, continuous or frequent courses of oral corticosteroids are introduced. The majority of people with asthma are treated at steps 1, 2 or 3

Reference:

• (1) NICE (2008).Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over