Diversity representation in the development of respiratory society guidance documents

Societal guidance documents, typically developed by diverse and multidisciplinary committees, are pivotal in supporting patient care and advancing research to improve respiratory health. This study evaluated panel member composition of guidance documents developed by two international respiratory societies, the American Thoracic Society (ATS) and the European Respiratory Society (ERS).

Guidance documents from society inception until December 2024 were identified using online repositories and journal websites for ATS and ERS. For each document, characteristics of panel members were extracted with verification by a second reviewer. Trend of panel member composition was assessed, pooling at 5-year intervals from 2005.

Of the 318 included documents, there were 3838 contributing unique panel members (43% respiratory physicians; 64% male; 59% from North America). The involvement of different medical specialists and nonmedical healthcare professionals was unchanged over time, with increased patient representation from none to 57%. The percentages of panel members with conflicts of interest consistently met the recommended threshold of <50%. There was an increase in the percentage of female representation as panel members from 27% between 2005 and 2009 to 41% between 2020 and 2024. Panel members from different continents beyond North America and Europe continued to increase, with 24% of documents having at least one member from low- or middle-income countries between 2020 and 2024.

There is increasing diversity in panel member composition in the development of international guidance documents in respiratory medicine. Ongoing efforts to maintain growing representation of panel members in international guidance documents are needed to incorporate broader perspectives and support applicability of clinical and research recommendations.