Key therapeutic topics were updated by NICE in 2018 to support medicines optimisation. These included:

Non-steroidal anti-inflammatory drugs (NSAIDs)

Ensure the following is adhered to:

• NSAID prescribing is reviewed regularly to ensure it is appropriate, especially in older people, and those who are at higher risk of gastrointestinal, renal and cardiovascular morbidity and mortality
• The prescriber uses the lowest effective dose and shortest duration of treatment to control the symptoms. Ibuprofen (1,200mg a day or less) or naproxen (1,000mg a day or less) should be used
• A proton pump inhibitor is prescribed with an NSAID for people who have osteoarthritis or rheumatoid arthritis.

Asthma medicines safety priorities

Recommendations within this guidance are for pharmacological treatments mainly aimed at people whose asthma is newly diagnosed or those who are uncontrolled on their current treatment. The recommendations include:

• Reviewing people with asthma who have been prescribed excessive reliever inhalers
• Monitoring asthma control at each review
• Using inhaled corticosteroids (ICS) as the first-choice regular preventer therapy for adults and children with asthma, adjusting the dose over time and aiming for the lowest dose required for effective asthma control
• Considering decreasing maintenance therapy when a person’s asthma has been controlled with their current maintenance therapy for at least three months
• Where long-acting beta agonists (LABAs) are prescribed for people with asthma, they should be prescribed with an ICS and not used alone
• Offering a written personalised action plan and education.

Type 2 diabetes

Guidelines for adults have been updated from the previous year and now recommend:

• Adopting an individualised approach to diabetes care, assessing benefits and risks
• Involving people with type 2 diabetes in decisions, including their HbA1c target
• Reassessing individual needs, circumstances and medicines at reviews, and optimising prescribing in line with clinical circumstances, preferences and needs, as well as cost, by choosing medicines with the lowest acquisition cost if two in the same class are appropriate
• Not routinely offering self-monitoring of blood glucose levels for adults.