Evidence
Surveillance decision
Surveillance decision
We will refresh the NICE guideline on asthma: diagnosis, monitoring and chronic asthma management (NG80). Changes will be made to recommendations 1.10.1 and 1.10.5 to include air pollution and its potential to exacerbate asthma, and approaches for minimising exposure to indoor and outdoor air pollution.
Background
Following the death of Ella Roberta Adoo Kissi-Debrah on 15 February 2013, an inquest (see the London Inner South Coroner's Court's record of inquest) was held from 30 November to 11 December 2020. In this landmark case, the assistant coroner, Philip Barlow, concluded that 9-year-old Ella died because of asthma contributed to by exposure to excessive air pollution. This is the first time that a coroner has found that air pollution was a contributory cause of illness and death.
The coroner concluded that 'air pollution was a significant contributory factor to both the induction and exacerbations to her asthma' and that the 'principal source of her exposure was traffic emissions'. The coroner also recorded that 'Ella's mother was not given information about the health risks of air pollution and its potential to exacerbate asthma', … '[i]f she had been given this information she would have taken steps which might have prevented Ella's death'.
NICE subsequently reviewed its guideline on asthma to assess whether the link between air pollution and asthma was covered.
Information considered in this exceptional surveillance review
We examined NICE guidelines that cover asthma or air pollution to check what information is provided about the link between air pollution and asthma.
The 2 guidelines that cover air pollution are:
Both guidelines provide recommendations about the link between air pollution and health, as well as guidance on approaches for minimising exposure to air pollution.
Recommendation 1.7.7 in NICE guideline NG70 provides information for vulnerable groups, including people with asthma, who are particularly affected by poor outdoor air quality. The advice covers how to minimise exposure.
Recommendations 1.5.1 to 1.5.3 in NICE guideline NG149 provide information for people with asthma who are affected by indoor air pollutants. Section 1.4 includes recommendations about ventilation and controlling sources of pollution.
The NICE guidelines NG70 and NG149 will not be amended.
NICE guideline NG80 does not mention a link between air pollution and asthma. Therefore, this guideline will be refreshed as outlined below.
Planned refresh: NG80
Changes are planned for NICE guideline NG80 to acknowledge the link between air pollution and asthma, as follows:
Recommendation 1.10.1
Recommendation 1.10.1 in the section on self-management currently states:
'Offer an asthma self-management programme, comprising a written personalised action plan and education, to adults, young people and children aged 5 and over with a diagnosis of asthma (and their families or carers if appropriate). [2017]'
The recommendation will be refreshed to state:
'For adults, young people and children aged 5 and over with a diagnosis of asthma (and their families or carers, as appropriate):
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Offer an asthma self-management programme, comprising a written personalised action plan and education.
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Explain that triggers can exacerbate asthma and include in the action plan approaches for minimising exposure to triggers, such as indoor and outdoor air pollution.
See the NICE guidelines on air pollution: outdoor air quality and health and indoor air quality at home for more guidance on how to minimise exposure and the effect of air pollution on health.'
Recommendation 1.10.5
Recommendation 1.10.5 in the section on self-management currently states:
'Consider an asthma self-management programme, comprising a written personalised action plan and education, for the families or carers of children under 5 with suspected or confirmed asthma. [2017]'
The recommendation will be refreshed to state:
'Consider an asthma self-management programme, comprising a written personalised action plan and education (including approaches to minimising exposure to indoor and outdoor air pollution), for the families or carers of children under 5 with suspected or confirmed asthma.'
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