2011, Number 1
Evaluation of clinical and methodological quality of clinical-practice guidelines for asthma management
Huerta LJG, Jiménez GC, Gómez GDR, Tavera RMG, López AJM
Full text
Language: Spanish
References: 23
Page: 5-28
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ABSTRACT
Background: Asthma is a frequent chronic disease during childhood, which presents an increase at world level. There are several definitions for asthma; among them, and according to the Global Initiative for Asthma (GINA), asthma consists of an inflammation of upper via, where certain cells and cell mediators play an important role characterized by recurrent episodes of sibilance, cough, dyspnoea, thoracic oppression, especially in the night and after midnight, associated with a higher or less level of obstruction. These last symptoms are often spontaneously reversible or it can be achieved through the use of medication. There are several risk factors triggering these condition; such as asthma or allergy family background, exposition to aeroallergens, viral infections, geographical factors, smoking, racial factors, male sex, low birth weight, and pregnancy, among other factors. Usually, asthma begins during childhood; most children develop it before being eight years old, and over the 50% of them, before three years old. Asthma appears due to the interrelation between genetic and environmental factors, as well as the individual’s idiosyncrasy. The diversity of systems of health attention services and asthma therapy availability that is recommended by the different clinical-practice guidelines must adapt to local conditions all over the world community. Moreover, public health authorities require information about the cost of asthma attention, about the way of managing this chronic disorder efficiently, and educational methods for services attending patients suffering from asthma, as well as the development of attention programs which may respond to particular needs and circumstances in every country all over the world. Justification of the study: The main objective of the present project consists of appraising clinical-practice guidelines (CPGs) for asthma management on pediatric patients. These guidelines are defined as the systematic development of recommendations aiming at helping doctors and patients make decisions related to specific circumstances in asthma treatments. Even though most guidelines have been historically developed from scholars’ lectures promoted by professionals or scientific groups or associations, lately explicit and rigorous methods have been used. It may be concluded that despite the fact that these guidelines are created according to evidence-based methodologies, they may present important deficiencies or inconsistencies that may compromise their validity. Upon the base of the aforementioned arguments, we will assess the design, structure and methodology of some of the clinical-practice guidelines for the management of patients at pediatric age. Objective: The general objective of this study is to evaluate the design, the structure and the methodology of CPGs for asthma management for pediatric patients by means of the AGREE (Appraisal of Guidelines for Research & Evaluation) I Instrument. Material and methods: The present is a transversal study with systematic revision. Every technical document with the denomination of clinical-practice guideline –making reference to asthma treatment for pediatric patients– was included in the study. The consulted data bases were: managers of data bases and CPGs searchers, compiling or Clearinghouse storage organizations and methodological centers. Results: In general, ten CPGs published between 2005 and 2009 were found. Once they had been evaluated through the AGREE I Instrument; only two of them (guideline 1 and 8) could be recommended according to the attributes of the measuring instrument. Discussion: In order to a guideline can be recommended, it must principally count on methodological rigor and applicability. In other words, on the one hand this means that the recommendation is based upon a systematic literature review: On the other hand, it must be assured that the information that was generated may be applied in diverse socio-cultural spheres. Therefore, the non-recommended guidelines are 4 and 5, since they do not present either methodological or applicability. Conclusions: According to the AGREE I Instrument, the guidelines Doughtery D, Mitchell J, Schatz M and colls. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma; and Bateman E, Boulet LP, Cruz AA, Levy ML and colls. Global Strategy for asthma management and prevention fit the category of guidelines which are very advisable, since they obtained over the 60% in the average Standardized Scoring.REFERENCES
Secretaría de Salud. Programa Nacional de Salud 2007-2012, por un México sano construyendo alianzas para una mejor salud. 1era Edición [monografía disponible en Internet] 2007[consultado 10 de febrero de2008] [aprox.185pp] Disponible en: www.alianza.salud.gob.mx/descargas/pdf/pns_version_completa.pdf