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.

Fig. 1

Evolution of asthma guidelines. First release = First release of asthma guidelines for the jurisdiction; revision = a new revised guideline was released; update = the previous guideline was updated based on new relevant literature; pediatric release = first release of asthma guidelines directed towards children; pediatric update = pediatric guidelines were updated based on new relevant literature.

Fig. 2

Framework for stages of assessment of asthma.

Fig. 3

Comparison of stages of assessment of asthma across guidelines.