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British guideline on the management of asthma: SIGN Clinical Guideline 141, 2014
  1. David R James1,
  2. Mark D Lyttle1,2
  1. 1Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  2. 2Academic Department of Emergency Care, University of the West of England, Bristol, UK
  1. Correspondence to Dr Mark D Lyttle, Academic Department of Paediatric Emergency Care, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK; Mark.lyttle{at}

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Clinical bottom line

  • Asthma continues to be one of the most prevalent long-term conditions in childhood and adolescents.

  • Long-term management involves a strong emphasis on supported self-management with the provision of personalised asthma action plans (PAAPs).

  • PAAPs should be reviewed at every clinical encounter alongside review of drug and lifestyle adherence to ensure good asthma control and prevention of asthma attacks.

  • Acute management continues to rest on the prompt delivery of inhaled or nebulised β2 agonists and oral or intravenous corticosteroids with several adjunctive intravenous therapies.

Information about the current guideline

This latest revision of national guidance on asthma management was produced jointly by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) in October 2014 and marks the largest revision to date including changes to the guideline structure.1 Established standards for guideline development were followed to produce recommendations for the emergency and long-term management of asthma in children, adolescents and adults. There was wide stakeholder input from national and international individuals and institutions, with opportunity for feedback via conferences and websites; the guideline was also reviewed by independent expert referees and underwent editorial review to ensure comments were addressed and bias was minimised. It provides a basis for high-quality care for acute and chronic asthma, and a stimulus for research in the areas in which evidence is still lacking.

Previous guidelines and associated resources

The first joint BTS/SIGN asthma guideline was published in 2003 as a ‘living guideline’, with annual updates between 2004 and 2012, and every two years since; this is the first such update. In this revision, BTS/SIGN have helpfully presented a new section of key recommendations for implementation and linked these to the National Institute for Health and Care Excellence (NICE) Quality Standard (QS) for asthma, which was published in February 2013.2

Key recommendations from BTS/SIGN guidance (NICE QS in italics where applicable)


  • When assessing children for a potential diagnosis of asthma, focus on key …

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  • Twitter Follow Mark Lyttle at @mdlyttle and David James @DrDaveJames

  • Contributors MDL conceived the idea for the paper. DJ provided the first draft, and both authors crafted this further to arrive at the final version.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.