1. Case studies: Identifying the treatment uncertainties of people with asthma & their clinicians Colin Gelder Asthma Editor DUETs

2. 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

3. 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

4. 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

5. 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

6. 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

7. http://www.ginasthma.com

10. 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

11. 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

12. 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

14. Gaps…… Many of key studies industry led Long term clinical studies Studies on children Studies on older individuals Symptoms Cure!

15. 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

16. 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

18. “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?

20. 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

21. 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

22. http://www.lindalliance.org/

23. 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 HealthStrategy and Development GroupMedical Research CouncilDepartment 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

24. 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.

25. 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

26. 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

29. 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

30. DUETs Developed and extended using the infrastructure of the specialist libraries of the national library for health (www.library.nhs.uk)www.library.nhs.uk Supported by team funded by MRC & DoH http://www.duets.nhs.uk

31. 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

49. 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

50. 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

51. 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

52. 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