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The table below consolidates the NICE recommendations for the management of patients with varying symptoms, differentiated by the presence or absence of asthmatic features or indicators of steroid responsiveness. This stepwise approach aids clinicians in identifying appropriate treatment options, ranging from initial intervention to advanced treatment considerations.
| Clinical Situation | No Asthmatic Features/Features Suggesting Steroid Responsiveness | Asthmatic Features/Steroid Responsiveness |
|---|---|---|
| Initial offer | SABA or SAMA (as needed) | SABA or SAMA (as needed) |
| Limited by symptoms/exacerbations | Offer LABA + LAMA | Consider LABA + ICS |
| Day-to-day symptoms impacting quality of life | Consider 3-month trial of LABA + LAMA + ICSb,c<br>If no improvement, revert to LABA + LAMA | Person has day-to-day symptoms that adversely impact QoL or has 1 severe or 2 moderate exacerbations within a year |
| 1 severe or 2 moderate exacerbations within a year | Consider LABA + LAMA + ICSb,c | Offer LABA + LAMA + ICSb,c |
| Persistent breathlessness/frequent exacerbations | Explore further treatments (see NICE guideline) | Explore further treatments (see NICE guideline) |
Notes:
a. Asthmatic features or features suggesting steroid responsiveness in this context include any previous secure diagnosis of asthma or atopy, a higher blood eosinophil count, significant variation in FEV1 over time (at least 400 ml), or significant diurnal variation in peak...
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