2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group (original) (raw)
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Implementation Science Communications
Background The 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group provides the first new clinical practice recommendations from the National Heart, Lung, and Blood Institute (NHLBI) since the previous 2007 asthma management guidelines. Guideline implementability was a high priority for the expert panel, and many approaches were undertaken to enhance the implementability of this clinical guideline update. Within the report, specific implementation guidance sections provide expanded summaries for each recommendation to quickly assist users. The implementation guidance incorporates findings from NHLBI-sponsored focus groups conducted with people who have asthma, caregivers, and health care providers. The findings were used to identify the types of information and tools that individuals with asthma, their caregivers, and their health care providers would find most ...
Allergology International, 1999
Asthma is a chronic, inflammatory disease of the airways that exacts a large burden of illness among patients, their families, and the health-care system. Yet advances in research have generated the means for addressing this public health problem. The challenge is to bridge the gap between excessive asthma morbidity and the science that holds the promise of reducing it; that is, to translate the scientific advances into meaningful recommendations for clinical care and to promote adoption of the recommendations. This paper will demonstrate how national asthma education programs, founded on science-based clinical practice guidelines, meet this challenge and help reduce illness and improve the quality of life for people with asthma.
Critical Analysis of Asthma Guidelines: Are They Really Evidence-Based?
Archivos de Bronconeumología ((English Edition)), 2008
Clinical guidelines are defined by "the systematic development of recommendations that have the aim of helping the practicing physician and the patient make decisions related to the specific circumstances of health care." 1 In the last decade, consensus statements or clinical guidelines have become increasingly important in clinical practice. Many of the daily decisions concerning patients or operative aspects of the management of health centers, and even decisions made by health managers, are therefore influenced by such documents. The marked increase in the number of guidelines published can largely be attributed to problems faced primarily in the health systems of countries of Europe, North America, Australia, and New Zealand, that is, the sharp increase in health costs along with increased demand, new and costly technologies, as well as the repercussions of the aging of the population, in combination with the desire of health professionals to offer (and the patients to receive) the best possible medical care. Thus, practicing physicians, health managers, and health policy makers see the guidelines as a means to providing more uniform and efficient health care, and to reducing the gap between what physicians actually do and what the scientific evidence indicates. 2,3 The main potential benefit of these guidelines or consensus statements is improved medical care for patients. Guidelines can make medical care more uniform and thus improve its quality. 4 Furthermore, they help ensure that patients are better informed about their therapeutic options,
A systematic review of the implementation and impact of asthma protocols
BMC Medical Informatics and Decision Making, 2014
Background: Asthma is one of the most common childhood illnesses. Guideline-driven clinical care positively affects patient outcomes for care. There are several asthma guidelines and reminder methods for implementation to help integrate them into clinical workflow. Our goal is to determine the most prevalent method of guideline implementation; establish which methods significantly improved clinical care; and identify the factors most commonly associated with a successful and sustainable implementation. Methods: PUBMED (MEDLINE), OVID CINAHL, ISI Web of Science, and EMBASE. Study Selection: Studies were included if they evaluated an asthma protocol or prompt, evaluated an intervention, a clinical trial of a protocol implementation, and qualitative studies as part of a protocol intervention. Studies were excluded if they had non-human subjects, were studies on efficacy and effectiveness of drugs, did not include an evaluation component, studied an educational intervention only, or were a case report, survey, editorial, letter to the editor. Results: From 14,478 abstracts, we included 101 full-text articles in the analysis. The most frequent study design was pre-post, followed by prospective, population based case series or consecutive case series, and randomized trials. Paper-based reminders were the most frequent with fully computerized, then computer generated, and other modalities. No study reported a decrease in health care practitioner performance or declining patient outcomes. The most common primary outcome measure was compliance with provided or prescribing guidelines, key clinical indicators such as patient outcomes or quality of life, and length of stay. Conclusions: Paper-based implementations are by far the most popular approach to implement a guideline or protocol. The number of publications on asthma protocol reminder systems is increasing. The number of computerized and computer-generated studies is also increasing. Asthma guidelines generally improved patient care and practitioner performance regardless of the implementation method.
ERS/EAACI statement on adherence to international adult asthma guidelines
European Respiratory Review, 2021
Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups.Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties via an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by HCPs of different specialties via systematic reviews.The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations made in different clinical settings, based on available resources. The systematic revi...
Overview of changes to asthma guidelines: diagnosis and screening
American family physician, 2009
The Expert Panel Report 3 of the National Asthma Education and Prevention Program represents a major advance in the approach to asthma care by emphasizing the monitoring of clinically relevant aspects of care and the importance of planned primary care, and by providing patients practical tools for self-management. Treatment of asthma should be guided by a new system of classification that assesses severity at initial evaluation and control at all subsequent visits. Asthma severity is determined by current impairment (as evidenced by impact on day-to-day activities) and risk of future exacerbations (as evidenced by frequency of oral systemic corticosteroid use), and allows categorization of disease as intermittent, persistent-mild, persistent-moderate, and persistent-severe. Initial treatment is guided by the disease-severity category. The degree of control is also determined by the analysis of current impairment and future risk. Validated questionnaires can be used for following the...
An academic, pharmaceutical and practice collaboration to implement asthma guidelines
Primary care respiratory journal : journal of the General Practice Airways Group, 2005
To investigate whether a patient review service changes the management of asthma in accordance with BTS/SIGN Guidelines. An observational study of routine review consultations for patients with asthma registered at 862 practices throughout the United Kingdom. Practices recorded reviews on a computer template and returned the information to an academic unit for analysis. 41,493 patients had data returned with 14,790 (36%) patients reporting symptoms at rest or on a daily basis and 15,840 (38%) patients over-using their short-acting beta2-agonist. 4,556 (74%) of patients with symptoms who had a subsequent consultation reported a reduction in their symptoms, whilst 3,932 (63%) reported a reduction in short-acting beta2-agonist use. Night-time, daytime, and activity symptom scores, and short-acting beta2-agonist use, were significantly reduced for patients reviewed more than once. There are a large proportion of patients suffering symptoms at rest or on a daily basis. There was a signif...
Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update
npj Primary Care Respiratory Medicine
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with “mild” asthma) as...
An evidence-based, point-of-care tool to guide completion of asthma action plans in practice
The European respiratory journal, 2017
Asthma action plans (AAPs) reduce healthcare utilisation, improve quality of life and are recommended across guidelines. However, fewer than 25% of patients receive an AAP, partly due to prescribers' inability to complete "yellow zone" instructions (how to intensify therapy for acute loss of control). We sought to review best evidence to develop a practical, evidence-based tool to facilitate yellow zone guidance in adults.We reviewed recent asthma guidelines and adult studies addressing acute loss of asthma control (January 2010 to March 2016). We developed evidence-based rules for yellow zone therapy and operational guidelines to maximise adherence and minimise errors.We reviewed three guidelines and 11 manuscripts (2486 abstracts screened). Recommendations were comparable but some areas lacked guidance. For 15/43 asthma regimens, the commonly recommended four- to five-fold yellow zone inhaled corticosteroid dose increase was problematic due to regulatory dose limits....