Cope Shannon F, Ungar Wendy J, Glazier Richard H
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont., Canada.
Int Arch Allergy Immunol. 2009;148(4):265-78. doi: 10.1159/000170380. Epub 2008 Nov 11.
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.
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.
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.
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.
在过去十年中，已推出了一些包含儿童哮喘管理指南的临床实践指南。儿童哮喘指南之间的一致性尚不清楚，且对确立哮喘控制的强调可能有所不同。本文的目的是描述儿童哮喘指南的演变，并从其组织架构、证据呈现以及对儿童的考量方面比较当前的国际指南，特别强调哮喘控制和严重程度的定义。
进行了一项系统性检索以识别哮喘指南，并搜索包含儿科术语的指南。比较了美国、全球哮喘防治创议、加拿大、英国和澳大利亚的指南在定义哮喘严重程度和控制评估时所采用的方法。
哮喘管理中的儿科考量已通过不同策略在不同程度上纳入了各种指南。在用于评估哮喘的概念和操作方法上存在差异，这些方法要么强调哮喘严重程度，要么强调哮喘控制。
对于未来的指南而言，明确界定主要评估参数是哮喘严重程度还是控制将很重要。描绘指南制定过程和支持证据可能会提高透明度、一致性以及对指南的依从性。
