North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of asthma in adults: Fig 1

The aim of this guideline is to provide recommendations (evidence based when possible) to guide primary health care professionals in their management of adult patients with asthma. It is a summary version of the full guideline,1 to which reference should be made for clarification or further information. The development group assumes that health care professionals will use general medical knowledge and clinical judgment in applying the general principles and specific recommendations in this document to the management of individual patients. Recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the practitioner in the light of available resources and circumstances presented by individual patients. Throughout this guideline categories of evidence (cited as I, II, and III) and the strength of recommendations (A, B, or C) are as described in the first article in the series.2 Aspects covered by the guideline are the use of peak flow measurement in diagnosis and management, drug treatment, non-drug treatment, and referral. All recommendations are for primary health care professionals and apply to adult patients attending general practice with asthma. Comment—British Thoracic Society guidelines state the aims of treatment as patients having the least possible symptoms; the least possible need for relieving bronchodilators; the least possible limitation of activity; the least possible circadian variation in peak flow; the least possible adverse effects from medicine; and the best peak flow possible.3 It is preferable to adjust treatment to cover exposure to day to day triggers such as exercise and cold air because avoidance imposes inappropriate restrictions on lifestyle. Specific comments about adjusting the dosages of drugs are made within the relevant sections on drug treatment.