Recommendation ID

Additional maintenance therapy for asthma uncontrolled on a moderate dose of ICS plus LABA with or without LTRA:- What is the clinical and cost effectiveness of offering additional maintenance therapy to adults, young people and children with asthma that is uncontrolled on a moderate dose of ICS plus LABA with or without LTRA?

Any explanatory notes
(if applicable)

Why this is important:- The evidence is insufficient in quantity and quality to support strong recommendations for the use of additional maintenance therapy beyond moderate dose ICS plus LABA. The clinical evidence tends to favour the addition of a long-acting muscarinic antagonist (LAMA) but the guideline  committee did not consider this to be conclusive, particularly because the addition of a LAMA is not cost effective compared with treatment with a placebo. In current practice, the alternative treatment options to adding a LAMA at this stage are increasing ICS dose to high, addition of theophyllines or a course of oral steroids. Therefore, to truly understand the cost effectiveness of LAMAs, a randomised controlled trial and health economic analysis taking into account the impact of LAMAs on oral steroid use and comparing the addition of LAMAs to any alternative strategy (as opposed to just placebo) is needed. The guideline committee felt the body of evidence, supported
by consensus agreement and current practice, was sufficient to weakly recommend the options of ICS high dose plus LABA, addition of a LAMA or theophylline or seeking advice from a healthcare professional with expertise in asthma. However, a study comparing these various strategies would be critical for stronger recommendations or a more specific order of options.

Source guidance details

Comes from guidance
Asthma: diagnosis, monitoring and chronic asthma management
Date issued
November 2017

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 30/11/2017