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Canadian Respiratory Journal
Volume 2016, Article ID 3085065, 12 pages
Research Article

Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis

1Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON, Canada M5S 1A8
2The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada M5B 1T8
3Department of Kinesiology, McMaster University, Hamilton, ON, Canada L8S 4L8
4University of Toronto, Toronto, ON, Canada M5S 1A8
5Family Physician Airways Group of Canada, Edmonton, AB, Canada T5X 4P8
6Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada G1V 4G5

Received 21 May 2015; Accepted 22 September 2015

Copyright © 2016 Samir Gupta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Several international groups develop asthma guidelines. Conflicting recommendations across guidelines have been described in several disease areas and may contribute to practice variability. Accordingly, we compared the latest Canadian Thoracic Society (CTS) asthma guideline with contemporaneous international asthma guidelines to evaluate conflicting recommendations and their causes. Methods. We identified the latest CTS asthma guideline update (2012) and the following societies which also updated their guidelines in 2012: the British Thoracic Society and Scottish Intercollegiate Guidelines Network and the Global Initiative for Asthma. We compared these three guidelines on (1) key methodological factors and (2) adult pharmacotherapy recommendations. Results. Methods used and documentation provided for literature search strategy and dates, evidence synthesis, outcomes considered, evidence appraisal, and recommendation formulation varied between guidelines. Criteria used to define suboptimal asthma control varied widely between guidelines. Inhaled corticosteroid dosing recommendations diverged, as did recommendations surrounding use of budesonide/formoterol as a reliever and controller and recommendations in the subsequent step. Conclusions. There are important differences between recommendations provided in contemporaneous asthma guidelines. Causes include differences in methods used for interpreting evidence and formulating recommendations. Adopting a common set of valid and explicit methods across international societies could harmonize recommendations and facilitate guideline implementation.