LAUSR

outstanding change in step 1. They immediately recommend a low dose of inhaled corticosteroids (ICS); while the GINA guidelines leave the first option for step 1 blank (Fig. 1) [1]. In this way, the BTS/SIGN guidelines have eradicated short-acting β2 agonists (SABA) as the unique option (Fig. 2). However, the explanatory text of both treatment diagrams stresses the risks of frequent SABA-only use and recommends that, with some exceptions, ICS should be prescribed to most adults with asthma. Hence, in the BTS/SIGN guidelines, SABA-only treatment is still recommended for patients who have “infrequent short-lived wheeze” [2, figure 2, p. 78], and the more detailed information on page 66 states that ICS should be considered for any patients with “an asthma attack in the last 2 years, using SABA 3 times a week or more, symptomatic 3 times a week or more, waking one night a week.” By contrast, in the GINA guidelines 2017 [1, p. 42], SABA-only treatment is reserved for patients with “asthma symptoms less than twice a We have found a great difference, at least in the treatment diagrams, between the GINA (ginasthma.com) [1] and the British Thoracic Society guidelines [2] (BTS/SIGN) for the management of asthma. The recently updated BTS/SIGN guidelines [2] show an Received: August 22, 2017 Accepted: October 24, 2017 Published online: December 14, 2017