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Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis.

Samir Gupta¹, Emily Paolucci², Alan Kaplan³

¹Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON, Canada M5S 1A8; The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada M5B 1T8.

Canadian Respiratory Journal

|July 23, 2016

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International asthma guidelines show significant differences in recommendations and methods. Harmonizing these approaches could improve asthma care consistency and implementation.

Area of Science:

Pulmonary Medicine
Clinical Guidelines
Evidence-Based Practice

Background:

Multiple international organizations develop asthma guidelines.
Discrepancies in recommendations across guidelines can lead to variations in clinical practice.
A comparison of guidelines is needed to identify and understand these conflicts.

Purpose of the Study:

To compare the Canadian Thoracic Society (CTS) asthma guideline with other international guidelines.
To identify conflicting recommendations and their underlying causes.
To evaluate methodological differences in guideline development.

Main Methods:

Comparison of the 2012 CTS asthma guideline with contemporaneous guidelines from the Global Initiative for Asthma and the British Thoracic Society/Scottish Intercollegiate Guidelines Network.

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Evaluation of key methodological factors including literature search, evidence synthesis, and recommendation formulation.

Analysis of adult pharmacotherapy recommendations.

Main Results:

Significant variations were observed in methods used for evidence synthesis, appraisal, and recommendation formulation.
Criteria for defining suboptimal asthma control differed substantially across guidelines.
Divergent recommendations were noted for inhaled corticosteroid dosing and the use of budesonide/formoterol.

Conclusions:

Contemporaneous asthma guidelines present important differences in recommendations.
Methodological variations in evidence interpretation and recommendation formulation contribute to these discrepancies.
Adopting standardized methods could harmonize international asthma guidelines and improve implementation.