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Asthma: a disease of variability
  1. Jo Congleton, DTB Associate Editor
  1. Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Jo Congleton, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; jo.congleton{at}

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The British Thoracic Society (BTS) 1990 asthma guideline placed inhaled corticosteroids (ICS) at the cornerstone of asthma management, resulting in marked improvement in asthma care. Subsequent updated guidelines have juggled with dose and time of introduction of ICS and latterly suggested a place for the addition of long-acting beta2 agonists (LABA) and leukotriene receptor antagonists (LTRA). Two UK guideline bodies (BTS/Scottish Intercollegiate Guideline Network [SIGN] and the National Institute for Health and Care Excellence [NICE]) give varying advice on both the order of therapies and diagnostic work-up. For example, NICE positions LTRA before ICS/LABA.1 There is further variation in the international Global Initiative for Asthma guideline, which in response to multiple recent large clinical trials now recommends ‘as needed ICS/LABA’ as the preferred option at an early step, while UK …

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  • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

  • Provenance and peer review Commissioned; externally peer reviewed.