Case studies: Identifying the treatment uncertainties of people

with asthma & their clinicians Colin Gelder

Asthma Editor DUETs

Conflicts of Interest

• Educational grants from AstraZeneca, Altana, GlaxoSmithKline to fund Attendance at annual meetings of American Thoracic Society & European Respiratory Societies

• Lecture/seminar fees from AstraZeneca, Altana, ALK, GlaxoSmithKline

• Advisory board fees from AstraZeneca, Altana/Nycomed, GSK

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Key Facts

• 5.2m people in the UK are currently receiving treatment for asthma: 1 in 12 adults & 1 in 10 children

• 4 out of 5 people with asthma in the UK suffer symptoms needlessly

• 2.6 million people in the UK suffer from severe asthma symptoms that impact significantly on their daily lives

Key Facts

• On average there are around 200 hospital admissions for asthma per day

• On average 4 people per day die from asthma

• The annual cost of asthma to the NHS is estimated at >£996 million

• Annual cost of asthma to society is £2.3bn

http://www.ginasthma.com

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

What do we know about asthma?

• Inflammatory disease(s) of airways

• Genetic & Environmental factors both play an important role in its development

• Genetics complex

• Allergens & irritants

• Role of infections in development of asthma and asthma exacerbations

Gaps……

• Many of key studies industry led

• Long term clinical studies

• Studies on children

• Studies on older individuals

• Symptoms

• Cure!

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

“Uncertainties about treatment, or the effects of treatment, that cannot currently be answered reliably by referring to up-to-date systematic reviews of existing research evidence”

What do we mean by an Uncertainty?

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

http://www.lindalliance.org/

James Lind Alliance

• The James Lind Alliance is a non-profit making initiative, being developed under the direction of a broadly-based Strategy and Development Group. Its Secretariat is funded by the Medical Research Council & the Department of Health

• Aims to identify the most important gaps in knowledge about the effects of treatments

• Purpose to bring patients and clinicians together in working partnerships to identify and prioritize unanswered questions that they agree are most important

JLA & Asthma

• At a Medicine and Me meeting on asthma at the Royal Society of Medicine in August 2004, Professor Stephen Holgate (British Thoracic Society) and Philippa Major (Asthma UK) expressed enthusiasm to Dr John Scadding (Co-convener of the James Lind Alliance) about establishing a James Lind Alliance (JLA) Working Partnership in Asthma.

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

DUETs: Aim

• Identify and publish uncertainties reflected in patients and clinicians questions about the effect of treatment which cannot be answered by referring to up-to-date reviews of existing research evidence

• Inform priorities for new research, particularly those developed under aegis of James Lind Alliance http://www.duets.nhs.uk

DUETs

• Developed and extended using the infrastructure of the specialist libraries of the national library for health (www.library.nhs.uk)

• Supported by team funded by MRC & DoH

http://www.duets.nhs.uk

DUETs

• A collection of known uncertainties– known to have either no systematic review or an up to

date systematic review shows that the answer is not available from research

http://www.duets.nhs.uk

ATTRACT

National library for Healthcare Primary Care question answeringservice

BTS/SIGNGuidelinesCochrane

BMJ ClinEvidenceNICE

Cochrane

NHS HTA

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Overview• Why is asthma important• What is known about asthma and its

treatment• Uncertainties• Role of James Lind Alliance • DUETs • Role of BTS in its partnership with

Asthma UK

Role of BTS

• Thorough review of asthma guidelines to reveal uncertainties

• Submission of questions to DUETs

• Prioritizing uncertainties

• James Lind Alliance priority setting meeting with Asthma UK

Acknowledgments

• Mark Fenton DUETs

• Stephen Holgate British Thoracic Society

• Sheila Edwards British Thoracic Society

• Bernard Higgins British Thoracic Society

• Sam Walker Asthma UK

• Jenny Versnel Asthma UK

• Ivor Cook Asthma UK

• James Lind Alliance• Iain Chalmers JLA