Tools and resources

1 Introduction

1 Introduction

This resource has been developed to provide practical information and advice on implementing the recommendations on diagnosis, in the NICE guideline on asthma: diagnosis, monitoring and chronic asthma management. NICE has suggested taking a phased approach to putting this guideline into practice.

Phased implementation for asthma diagnosis

NICE recommends objective testing with spirometry and FeNO for most people with suspected asthma. This is a significant enhancement to current practice, which will take the NHS some time to implement, with additional infrastructure and training needed in primary care. New models of care, being developed locally, could offer the opportunity to implement these recommendations. This may involve establishing diagnostic hubs to make testing efficient and affordable. They will be able to draw on the positive experience of NICE's primary care pilot sites, which trialled the use of FeNO.

The investment and training required to implement the new guidance will take time. In the meantime, primary care services should implement what they can of the new guidelines, using currently available approaches to diagnosis until the infrastructure for objective testing is in place.

(Statement taken from the guideline's section on putting this guideline into practice.)

By using this resource, staff in healthcare services will be able to follow the phased implementation suggestions in the statement above:

  • Implement what they can of the new guideline using currently available approaches to diagnosis. See section 2 and section 3 for assessing what can be implemented locally now and section 4 for examples of how to make these changes.

  • Plan investment and training. See section 3 for identifying locally what additional investment and training is needed and section 4 for how to access this.

  • Take the opportunity from new models of care being developed locally to implement the recommendations. The information resulting from the application of sections 3 and section 4 will provide evidence, data and learning to help plan new models of care. See section 5 for learning from contributors to ensure that implementing the asthma diagnosis recommendation is a priority during the development of new models of care.

NICE's adoption team worked with:

  • general practice staff with experience of implementing the guideline's diagnostic algorithms as part of a feasibility project (appendix Q, page 835) during guideline development

  • commissioners and service managers with responsibility for primary care respiratory services also contributed to this resource.

Contributors are listed in the acknowledgements section.

The benefits of implementing the diagnosis recommendations in the guideline, reported by the sites taking part in the feasibility project, include:

  • getting asthma diagnosis right first time by using a more structured and consistent approach

  • increasing healthcare professionals' confidence in diagnosis

  • improving patient experience by reducing the number of appointments for an accurate diagnosis

  • reducing inappropriate prescribing of inhalers

  • reducing the loss of patients to follow up.

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