SUMMARY

* The British Thoracic Society's 'Guidelines on the management of asthma' are one of the best known and widely used consensus guidelines available. They have been updated recently.

* The guidelines retain the stepwise approach to the drug treatment of chronic asthma. Many of the recommendations made in the last revision remain valid (see enclosed charts).

* Among the changes are: new recommendations on salmeterol; the inclusion of fluticasone propionate; an emphasis on the need to gain early control; and, use of inhaled corticosteroids in children, as an alternative to sodium cromoglycate at step2.

* Fluticasone propionate is an inhaled corticosteroid which came onto the market in Britain in 1993. It is now included in the guidelines as an alternative to beclomethasone dipropionate (BDP) and budesonide.

* When given by metered-dose inhaler, the recommended dose for fluticasone is half that of the other two drugs as it appears to be more potent. However, at comparable doses, it is not more effective.

* Fluticasone has lower oral bioavailability than BDP and budesonide. However, inhaled corticosteroids are also absorbed systemically from the lung. Fluticasone shares the potential for causing systemic adverse effects. All inhaled corticosteroids should be used at the lowest dose compatible with asthma control.

* In the absence of any clear cut differences in efficacy and safety, the decision on which inhaled corticosteroid to prescribe should be based on the suitability of the device for the patient, and cost.