Practice Guidelines
Summary of Recommendations from the Canadian Asthma Consensus Report, 1999
This review may be edited
Posted By: The Seat of Our Pants Discussion Group
Posted Date: June 29, 2000
Title: Summary of Recommendations from the Canadian Asthma Consensus Report, 1999
Authors: Louis-Philippe Boulet, Allan Becker, Denis Berube, Robert Beveridge, Pierre Ernst
Reference: CMAJ 1999 Nov; 161(11suppl):S1-S12
Link: Click here for a direct link to the paper. A password may be required for access to fulltext.
OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings.
OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma.
OUTCOMES: Provision of the best control of asthma by confirmation of the diagnosis using objective measures, rapid achievement and maintenance of control and regular follow-up.
EVIDENCE: The key diagnostic and therapeutic recommendations are based on the 1995 Canadian guidelines and a critical review of the literature by small groups before a full meeting of the consensus group. Recommendations are graded according to 5 levels of evidence. Differences of opinion were resolved by consensus following discussion.
VALUES: Respirologists, immunoallergists, pediatricians and emergency and family physicians gave prime consideration to the achievement and maintenance of optimal control of asthma through avoidance of environmental inciters, education of patients and the lowest effective regime of pharmacotherapy to reduce morbidity and mortality.
BENEFITS, HARMS AND COSTS: Adherence to the guidelines should be accompanied by significant reduction in patients' symptoms, reduced morbidity and mortality, fewer emergency and hospital admissions, fewer adverse side-effects from medications, better quality of life for patients and reduced costs.
RECOMMENDATIONS: Recommendations are included in each section of the report. In summary, after a diagnosis of asthma is made based on clinical evaluation, including demonstration of variable airflow obstruction, and contributing factors are identified, a treatment plan is established to obtain and maintain optimal asthma control. The main components of treatment are patient education, environmental control, pharmacotherapy tailored to the individual and regular follow-up.
VALIDATION: The recommendations were distributed to the members of the Canadian Thoracic Society Asthma and Standards Committees, as well as members of the board of the Canadian Thoracic Society. In addition, collaborating groups representing the Canadian Association of Emergency Physicians, the Canadian College of Family Physicians, the Canadian Paediatric Society and the Canadian Society of Allergy and Immunology were asked to validate the recommendations. The recommendations were discussed at regional meetings throughout Canada. They were also compared with the recommendations of other similar groups in other countries.
DISSEMINATION AND IMPLEMENTATION: An implementation committee has established a strategy for disseminating these guidelines to physicians, other health professionals and patients and for developing tools and means that will help integrate the recommendations into current asthma care. The plan is outlined in this report.
Are the results of the study valid?
Were all important options and outcomes clearly specified?
Yes! A comprehensive list of diagnostic tools were used (i.e. spirometry) and the various levels of asthma were listed as outcomes.
Was an explicit and sensible process used to identify, select, and combine evidence?
Since it is a revision of a previous recommendation there was no reference to the type of literature review.
Was an explicit and sensible process used to consider the relative value of different outcomes?
Yes! They refer to a table that outlines there weighting of the evidence and the corresponding recommendation (i.e. Level I-the highest, Level V-the lowest).
Is the guideline likely to account for important recent developments?
Considering the publication date, it would appear that it is recent (i.e. various delivery devices, drugs etc.)
Has the guideline been subject to peer review and testing?
What were the results?
Are practical, clinically important, recommendations made?
Yes! The recommendations are even divided amongst patient populations.
How strong are the recommendations?
Each recomendation's strength is supported by an assigned value referring to its level of evidence.
What is the impact of uncertainty associated with the evidence and values used in the guidelines?
Clearly defined levels of evidence allow the reader to determine the viability of each recommendation.
Will the results help me in caring for my patients?
Is the primary objective of the guideline consistent with your objective?
Yes! Especially as a practicing physician in rural Southwestern Ontario.
Are the recommendations applicable to your patients?
Yes! Please see 1.

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