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Management of asthma exacerbations in the paediatric population: a systematic review
Sara Manti1,2, Amelia Licari3,2, Salvatore Leonardi1
1Dept of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
Insights
Asthma exacerbation guidelines for children show significant variability in clinical practice. Updated, comprehensive guidelines are needed to improve care quality and standardize treatment globally.
Area of Science:
- Pediatric Pulmonology
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Pediatric asthma exacerbations are a leading cause for emergency visits and hospitalizations.
- A significant gap exists between asthma management guidelines and actual clinical practice.
- This discrepancy impacts diagnostic and treatment decisions for children with asthma.
Purpose of the Study:
- To systematically review existing clinical practice guidelines for managing pediatric asthma exacerbations.
- To identify variations and inconsistencies in diagnostic and therapeutic recommendations.
Main Methods:
- A systematic literature review of guidelines published from January 2009 to October 2019.
- Protocol registered with PROSPERO (CRD42020221562).
Main Results:
- Sixteen guidelines for pediatric asthma exacerbations were analyzed.
- While definitions of exacerbation were consistent, disease severity and control assessments varied widely.
- Few guidelines provided clear criteria for hospitalization and discharge.
- Many guidelines lacked stakeholder involvement and editorial independence.
Conclusions:
- Developing comprehensive, updated guidelines aligned with international standards is crucial.
- Improved guidelines can enhance clinical practice quality and promote evidence-based, uniform treatment.
- Standardization of care can reduce variability in managing pediatric asthma exacerbations.
Background:
Asthma exacerbations in children is one of the most common medical conditions requiring urgent visits to primary healthcare providers or emergency departments, and even hospitalisations. Currently, there is significant variation in the management of asthma exacerbations expressed in guideline recommendations versus clinical practice. This disconnect affects diagnostic and treatment decisions for the clinician and patient.
Objective:
We systematically reviewed the available guidelines providing recommendations for diagnostic and therapeutic management of asthma exacerbations in the paediatric population.
Methods:
A systematic review of the literature for guidelines published between January 2009 and October 2019 was conducted, using a protocol registered with the international prospective register of systematic reviews (PROSPERO CRD42020221562).
Results:
16 asthma exacerbation clinical practice guidelines for children were included. Despite general agreement between guidelines on the definition of asthma exacerbation, there was great variability in the definition of disease severity and assessment of asthma control. This systematic review also highlighted a paucity of recommendations for criteria for hospitalisation and discharge. Many guidelines scored poorly when measured for stakeholder involvement and editorial independence.
Conclusion:
Comprehensive and updated guidelines compliant with international standards for clinical guidelines may significantly improve clinical practice quality, promote evidence-based recommendations and provide uniformity of treatment between countries.
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