International Differences in Asthma Guidelines for Children

Abstract

Background: Over the last decade, a number of clinical practice guidelines that include guidance for the management of pediatric asthma have been introduced. The consistency across pediatric asthma guidelines is unknown and the emphasis on establishing asthma control may vary. The objective of this paper was to depict the evolution of guidelines for pediatric asthma and to compare current international guidelines in terms of their organization, presentation of evidence and consideration of children, with special emphasis on definitions of asthma control and severity. Methods: A systematic search to identify asthma guidelines was conducted, and guidelines were searched for pediatric terms. The approaches used by guidelines to define assessments of asthma severity and control were compared between the United States, the Global Initiative for Asthma, Canada, the United Kingdom and Australia. Results: Pediatric considerations in the management of asthma have been integrated into the various guidelines to different degrees and through varied strategies. There were differences in the conceptual and operational approach used to assess asthma which emphasized either asthma severity or control. Conclusions: It will be important for future guidelines to clearly define whether the primary assessment parameter is asthma severity or control. Delineating the guideline development process and supporting evidence may improve transparency, consistency and guideline adherence.

The Saudi initiative for asthma - 2012 update: Guidelines for the diagnosis and management of asthma in adults and children

“…controlled, partly controlled, uncontrolled) which may vary markedly over short period of time and should entail short-term evaluations of current asthma status, asthma burden, and medical management. [222] Focusing on asthma control may improve patient perceptions and expectations that are commonly low in children, caregivers, and clinicians. This may in turn improve symptom reporting by children and parents, and treatment decisions by clinicians.…”

“…This may in turn improve symptom reporting by children and parents, and treatment decisions by clinicians. [222]…”

Identification of asthma phenotypes in children

“…Most recent guidelines suggest some sort of phenotypic classification to guide initial treatment [1,10,34,35], stressing the need for reevaluation to assess treatment effect. However, trying to distinguish childhood asthma subgroups by symptoms, comorbidities, inflammatory markers, response to treatment or other features has so far not been very useful in the clinical setting [36].…”

Quantifying preferences for asthma control in parents and adolescents using best–worst scaling

“…An international comparison of asthma guidelines for children revealed important differences regarding which parameters were considered worthy of inclusion, as well as how levels of asthma control were defined for each parameter [9]. None of the guidelines assign weights to the parameters, yet there is evidence from clinical practice to suggest that some parameters, such as prior exacerbations, are better predictors of poor control [10,11].…”

“…None of the guidelines assign weights to the parameters, yet there is evidence from clinical practice to suggest that some parameters, such as prior exacerbations, are better predictors of poor control [10,11]. Variation between guidelines suggests that uncertainty prevails among clinical experts in how to best to define and achieve asthma control in children [9].…”