Myers Timothy R
Pediatric Diagnostics and Respiratory Care, Rainbow Babies and Children's Hospital, and Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Respir Care. 2008 Jun;53(6):751-67; discussion 767-9.
The first clinical practice guidelines for the assessment and management of asthma were published over 20 years ago in New Zealand and Australia. During the same period, British and Scottish groups were collaborating on a United Kingdom version of asthma guidelines. Shortly after the introduction of the New Zealand and Canadian guidelines, the National Heart, Lung, and Blood Institute of the United States National Institutes of Health participated in 2 additional asthma guideline endeavors, which were published in the early 1990s. The National Heart, Lung, and Blood Institute formed the National Asthma Education and Prevention Program to develop asthma guidelines for the United States, and participated with an international task force to develop guidelines for the treatment of asthma in all countries, which resulted in the formation of the Global Initiative for Asthma in the mid-1990s. The asthma guidelines issued by professional societies and other groups prior to the late 1990s were primarily based on consensus or expert opinion in each guideline committee, though those opinions were based on the available studies. The early guidelines played a vital role in bridging the gap between various treatment options and recent discoveries in basic science, and served as the vehicle to implementation into daily clinical practice. Asthma guidelines have been published and revised in dozens of countries around the world and have become reputable directives or "road maps" in asthma diagnosis, treatment, and management for patients of all ages. The guidelines have similar formats. The dissemination and implementation of the early guidelines was inconsistent, and they were criticized for not being evidence-based. As the knowledge of asthma pathophysiology continues to expand, along with basic science research on asthma diagnosis, treatment, and management, as well as education of the asthma patient, it is essential that the asthma guidelines be frequently updated and based on evidence-based-medicine processes.
首份关于哮喘评估与管理的临床实践指南于20多年前在新西兰和澳大利亚发布。同一时期，英国和苏格兰的团队正在合作制定英国版的哮喘指南。在新西兰和加拿大的指南推出后不久，美国国立卫生研究院的国家心肺血液研究所又参与了另外两项哮喘指南工作，这两项指南于20世纪90年代初发布。国家心肺血液研究所成立了国家哮喘教育与预防项目，以制定美国的哮喘指南，并与一个国际特别工作组合作，为所有国家制定哮喘治疗指南，这促成了20世纪90年代中期全球哮喘防治创议的形成。20世纪90年代末之前，专业协会和其他团体发布的哮喘指南主要基于每个指南委员会的共识或专家意见，尽管这些意见是基于现有研究得出的。早期的指南在弥合各种治疗选择与基础科学最新发现之间的差距方面发挥了至关重要的作用，并成为将这些知识应用于日常临床实践的工具。世界各地已有数十个国家发布并修订了哮喘指南，这些指南已成为各年龄段哮喘患者诊断、治疗和管理方面备受认可的指令或“路线图”。这些指南格式相似。早期指南的传播和实施并不一致，且因缺乏循证依据而受到批评。随着哮喘病理生理学知识的不断扩展，以及哮喘诊断、治疗和管理方面的基础科学研究以及哮喘患者教育的发展，哮喘指南必须频繁更新并基于循证医学流程，这一点至关重要。
