Asthma management: Are GINA guidelines appropriate for daily clinical practice?

Abstract

SummaryAn international group of primary care asthma experts, as well as pulmonologists and allergists from Europe and the US, met to discuss asthma management focused on the primary care office. This paper summarizes their discussions. Accuracy of diagnosis and appropriateness of treatment is variable depending on the clinical circumstances and patient group. The value of classifying patients based on baseline or static asthma severity scores remains controversial, and asthma management decisions based on symptom control appear to have greater practical utility in a primary care setting. Furthermore, it must be recognized that patients, caregivers and physicians may have differing, and possibly conflicting, goals for therapy. There are many initiatives to improve the quality of asthma management, for example, primary care-focused guidelines being developed by the International Primary Care Respiratory Group, and several groups are working on asthma control scores. In addition, new therapies may improve the options available for increasing compliance and reducing side effects. In conclusion, asthma management should be patient-focused, with outcomes relevant to improving the quality of life for people with asthma.

Asthma incidence and accuracy of diagnosis in the Portuguese sentinel practice network

“…Due to the limitations of guidelines, 26,27 the difficulties encountered by physicians in adhering to them, 28 and difficulties in clinical practice in managing asthma in line with recommendations, 29 the International Primary Care Airways Group (IPAG) produced its own guidelines for primary care physicians in 2005. 30 Together with the IPCRG guidelines, 14 these provide a more practical approach than the GINA Guidelines.…”

Leitlinie zur Behandlung des Asthma bronchiale bei Kindern und Jugendlichen

“…Ein weiterer Schwerpunkt in der vorliegenden Leitlinie ist das Konzept, die Therapie gemäß Symptomenkontrolle und patientenfokussiert zu steuern sowie Asthmaschulungsmaßnahmen zu integrieren [1, 10,11]. Da im Jahr 2006 von der selben Autorengruppe eine Empfehlung zur Behandlung der rezidivierenden obstruktiven Bronchitis und des Asthma bronchiale im Vorschulalter erstellt wurde [12,13] …”

Guideline-defined asthma control: a challenge for primary care

“…Furthermore, implementation of key guideline recommendations was variable, both within and between practices. Some authors have suggested that shared patient goals may be a way of improving adherence to guidelines [8,9]. This in itself is a wonderful aim; to include patients in determining acceptable outcomes.…”