Tools and resources
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 published in 2017. NICE 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.
Update August 2021
NICE has worked with the Accelerated Access Collaborative (AAC), on rolling out FeNO testing to help improve the diagnosis of asthma. A toolkit has been developed to help implement FeNO testing locally and is available on the Wessex AHSN website. This provides downloadable tools and resources to support NHS organisations with the adoption and implementation of FeNO testing to improve the outcome for people with suspected and confirmed asthma.
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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