The National Institute for Health and Clinical Excellence has published final guidance this morning recommending the use of inhaled corticosteroids for the treatment of chronic asthma in adults and children from 12 years of age on the NHS.

Current estimates put the number of people with asthma in the UK at around 5.2 million and the condition costs the NHS over £996 million a year and the economy a further 12.7 million lost working days. Furthermore, according to Asthma UK, there were just over 1,300 deaths from asthma in 2005, but it stressed that an estimated 75% of hospital admissions are avoidable and as many as 90% of related deaths are preventable, highlighting the urgent need for effective strategies to manage the disease.

Poorly-controlled asthma can have a significant impact on the quality of life of the patient and their family, noted Professor Peter Littlejohns, NICE Clinical and Public Health Director and Executive Lead for this guidance, and asthma management is based on controlling symptoms, preventing exacerbations and achieving the best possible lung function with minimal treatment side effects.

ICSs suppress inflammation in the lungs and are recommended for prophylactic treatment of asthma, and there are currently five formulations available on the UK market: beclometasone dipropionate, AstraZeneca’s Pulmicort (budesonide), GlaxoSmithKline’s Flixotide (fluticasone), Schering-Plough’s Asmanex (mometasone furoate) and Nycomed’s (formerly Altana Pharma) Alvesco ciclesonide.

Cost-effective approach
After reviewing all the evidence available, an independent advisory committee to NICE concluded that the use of ICSs for asthma is indeed a cost-effective use of NHS resources, but it was stressed that “the least costly product that is suitable for an individual” should be used.

Furthermore, if treatment with ICS and a long-acting beta-2 agonist is deemed necessary, the use of a combination device - GlaxoSmithKline’s Advair/Seretide (fluticasone/salmeterol), AstrasZeneca’s Symbicort (budesonide/formoterol fumarate) or Trinity-Chiesi’s recently approved Fostair (beclometasone dipropionate/formoterol fumarate dihydrate) - is recommended, although whether to use single agents or a combination should the made on an individual basis, the Institute said.