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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma

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Published on: November 4, 2010

Delphi project in bronchial asthma. Two stages.

M Fernández-Benítez¹, M Ibero Iborra, J Sanz Ortega

¹Clínica Universidad de Navarra, Pamplona, Spain. mfernandeb@unav.es

Allergologia Et Immunopathologia

|May 15, 2010

Summary

Two Delphi studies on pediatric bronchial asthma revealed improved expert consensus over time. Recent guidelines, like GEMA, significantly increased agreement on diagnosis and treatment, particularly for young children.

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Area of Science:

Pediatric Pulmonology
Allergy and Immunology
Health Services Research

Background:

Bronchial asthma management in children presents unique challenges.
Previous expert consensus documents showed areas of controversy, particularly regarding early childhood treatment and immunotherapy.
Evolving guidelines aim to standardize and improve pediatric asthma care.

Purpose of the Study:

To compare two Delphi processes on pediatric bronchial asthma management.
To assess changes in expert opinion and consensus over time.
To evaluate the impact of updated guidelines on expert agreement.

Main Methods:

Two Delphi studies were conducted: one based on a consensus document from five associations, and a more recent one using GEMA (Spanish Guidelines on the Management of Asthma).
A descriptive study compared the Delphi processes, analyzing consensus levels on specific questions.
Questionnaires were administered to expert panels to gauge agreement on diagnosis and treatment strategies.

Main Results:

The initial consensus document faced significant controversy regarding treatment for children under three and immunotherapy for allergic asthma.
The Delphi process using GEMA demonstrated a substantial increase in expert consensus, reaching 87.5% agreement in the first round.
Specifically for pediatric diagnosis and treatment, the GEMA-based Delphi achieved full consensus in the first round, with only minor disagreements in the second round (8.92%).

Conclusions:

Clinical guidelines and consensus documents, such as GEMA, can effectively modify expert behavior regarding asthma diagnosis and treatment.
The Delphi methodology, when applied to updated guidelines, enhances expert agreement and potentially improves patient care.
There has been a measurable improvement in expert consensus on pediatric bronchial asthma management following the implementation of newer guidelines.