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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MeReC Extra 34

The National Prescribing Centre (NPC) has published MeReC Extra 34 (PDF).

This MeReC covers the recent revisions to the British Asthma Guideline from SIGN and BTS, additional data from two studies adding to the growing evidence that routine self-monitoring of blood glucose is unlikely to be beneficial in patients with type 2 diabetes who are not treated with insulin.

There is also a discussion of the impact on current practice of a recent systematic review that provided limited evidence that montelukast may potentially be safer than inhaled salmeterol in the long term. Long acting beta-agonists are still first line choice at step 3 of the Asthma Guidelines however attention is drawn to recent safety advice from the Medicines and Healthcare products Regulatory Agency.

It is recommended that long acting beta agonists (formoterol and salmeterol) should:

  • Be added only if regular use of standard-dose inhaled corticosteroids has failed to control asthma adequately
  • Not be initiated in patients with rapidly deteriorating asthma
  • Be introduced at a low dose and the effect properly monitored before considering dose increase
  • Be discontinued in the absence of benefit
  • Be reviewed as clinically appropriate: stepping down therapy should be considered when good long-term asthma control has been achieved

Action: Clinicians involved in the treatment of respiratory illness or diabetes will find this MeReC Extra to be useful and informative.

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