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International differences in asthma guidelines for children
Shannon F Cope1, Wendy J Ungar, Richard H Glazier
1Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont., Canada.
Insights
Pediatric asthma guidelines vary in their approach to assessing severity versus control. Future guidelines should clarify their primary focus for better consistency and adherence in managing childhood asthma.
Area of Science:
- Pediatric Pulmonology
- Clinical Practice Guidelines
- Asthma Management
Background:
- Multiple clinical practice guidelines for pediatric asthma management have emerged over the past decade.
- The consistency and varying emphasis on asthma control across these guidelines remain unclear.
- This study aims to map the evolution and compare current international pediatric asthma guidelines.
Purpose of the Study:
- To depict the evolution of pediatric asthma guidelines.
- To compare current international guidelines regarding organization, evidence presentation, and pediatric considerations.
- To emphasize definitions of asthma control and severity in pediatric asthma management.
Main Methods:
- Systematic literature search for asthma guidelines.
- Focused search for guidelines incorporating pediatric terms.
- Comparative analysis of assessment approaches for asthma severity and control in guidelines from the US, GINA, Canada, UK, and Australia.
Main Results:
- Pediatric considerations are integrated into guidelines with varying degrees and strategies.
- Significant differences exist in the conceptual and operational approaches to asthma assessment.
- Guidelines emphasize either asthma severity or asthma control, but not consistently.
Conclusions:
- Future guidelines must clearly define whether asthma severity or control is the primary assessment parameter.
- Improved transparency and consistency in guideline development processes are needed.
- Delineating the evidence base can enhance guideline adherence for pediatric asthma.
Background:
Over the last decade, a number of clinical practice guidelines that include guidance for the management of pediatric asthma have been introduced. The consistency across pediatric asthma guidelines is unknown and the emphasis on establishing asthma control may vary. The objective of this paper was to depict the evolution of guidelines for pediatric asthma and to compare current international guidelines in terms of their organization, presentation of evidence and consideration of children, with special emphasis on definitions of asthma control and severity.
Methods:
A systematic search to identify asthma guidelines was conducted, and guidelines were searched for pediatric terms. The approaches used by guidelines to define assessments of asthma severity and control were compared between the United States, the Global Initiative for Asthma, Canada, the United Kingdom and Australia.
Results:
Pediatric considerations in the management of asthma have been integrated into the various guidelines to different degrees and through varied strategies. There were differences in the conceptual and operational approach used to assess asthma which emphasized either asthma severity or control.
Conclusions:
It will be important for future guidelines to clearly define whether the primary assessment parameter is asthma severity or control. Delineating the guideline development process and supporting evidence may improve transparency, consistency and guideline adherence.
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