Recommendations for research

This content is from the BTS, NICE and SIGN guideline - Asthma: diagnosis, monitoring and chronic asthma management (SIGN 245), 2024.

The guideline committee has made the following recommendations for research.

Key recommendations for research

1 Medicines for initial management

What is the clinical and cost-effectiveness of regular ‘fixed-dose’ inhaled corticosteroid (ICS) regimens (using SABA [short-acting beta₂ agonist] as a reliever) compared with ‘as-needed’ strategies (for example ICS/formoterol) as the initial standard treatment for asthma in children aged 5 to 11 years? [BTS/NICE/SIGN 2024]

For a short explanation of why the committee made this recommendation for research, see the rationale and impact section on medicines for initial management in children aged 5 to 11.

Full details of the evidence and the committee’s discussion are in evidence review P: drug classes for initial asthma management.

2 Medicine combination and sequencing

What is the best step-up treatment for people whose asthma is not controlled on a combination inhaler of ICS plus formoterol used as needed? [BTS/NICE/SIGN 2024]

For a short explanation of why the committee made this recommendation for research, see the rationale and impact section on medicine combination and sequencing in people aged 12 and over.

Full details of the evidence and the committee’s discussion are in evidence review Q: drug combinations and sequencing for asthma management.

3 Diagnostic pathways

What is the cost-effectiveness and feasibility of the proposed BTS/NICE/SIGN diagnostic pathways for asthma in children and young people aged 5 and over and in adults aged 17 and over? [BTS/NICE/SIGN 2024]

For a short explanation of why the committee made this recommendation for research, see the rationale and impact section on objective tests for diagnosing asthma in adults, young people and children aged 5 to 16 with a history suggestive of asthma.

Full details of the evidence and the committee’s discussion are in:

4 Inhalers

Can digital inhaler monitors cost-effectively improve adherence to preventer inhalers for people with asthma? Does this improve asthma control and who would benefit most from this intervention? [BTS/NICE/SIGN 2024]

For a short explanation of why the committee made this recommendation for research, see the rationale and impact section on digital inhalers.

Full details of the evidence and the committee’s discussion are in evidence review R: smart inhalers.

5 Monitoring inhaler technique

What is the current frequency and the current method being used to check the inhaler technique of people with asthma? What is the optimal frequency and the best method of checking inhaler technique to improve clinical outcomes for people with asthma? [NICE 2017]

6 Monitoring asthma control using telehealthcare

What is the long-term (more than 12 months) clinical and cost-effectiveness of using telehealthcare as a means to monitor asthma control in adults, young people and children? Methods of telehealthcare can include telephone interview (with healthcare professional involvement) and internet or smartphone-based monitoring support (no healthcare professional involvement). [NICE 2017]

7 Decreasing pharmacological treatment

In adults, young people and children with well-controlled asthma, what are the objective measurements and prognostic factors that indicate that a decrease in regular maintenance treatment is appropriate? [NICE 2017]

8 Improving adherence to asthma medication

What are the most clinically and cost-effective strategies to improve medicines adherence in adults, young people and children with asthma who are non-adherent to prescribed medicines? [NICE 2017]

Other recommendations for research

Increasing the dose of ICS within a personalised self-management programme for children and young people

For children and young people with asthma that is managed in primary care, is there an advantage to increasing the ICS dose when asthma control has deteriorated compared with using the usual dose in a self-management programme? [NICE 2020]

For a short explanation of why the committee made this recommendation for research, see the rationale and impact section on self-management.

Full details of the evidence and the committee’s discussion are in evidence review from NG80: increasing ICS treatment within supported self-management for children and young people.