Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis

Table 1

Guideline methodologies.

Process	CTS 2012	GINA 2012	BTS 2012
Literature search	Guidelines^1: MEDLINE, EMBASE, National Guidelines Clearinghouse, CMA Infobase, and GIN (2005 to June 2010); Systematic reviews: MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews (to October 2010); RCTs: MEDLINE, EMBASE, and Cochrane Airways Group Register of Trials (to October 2010)^2	PubMed (to June 2012); Invitation to “respiratory community” to provide additional abstracts/papers	EMBASE 1980–February 2010; CINAHL 1982–February 2010; MEDLINE 1966–December 2009^3
Evidence selection	By informal consensus of 3-4-member working groups	By “at least” 2 committee members	By SIGN Executive staff (preliminary), then 1-2 committee members (based on defined inclusion/exclusion criteria)
Evidence synthesis	2 reviewers created data extraction tables	Not provided	SIGN Executive staff created evidence tables after appraisal
Outcomes considered	Need for systemic corticosteroid for exacerbation; ED visits; hospitalizations; time to exacerbation; duration/intensity of exacerbation symptoms; rescue beta2-agonist use; pulmonary function; airway inflammatory markers; quality of life; withdrawals; adverse effects	Not provided	Not provided
Evidence appraisal	AGREE II (for guidelines), AMSTAR (for reviews); Cochrane Risk of Bias instruments (for RCTs)	Each assigned member answered four questions indicating scientific impact^4	MERGE checklists
Recommendation formulation	Used GRADE scale; anonymous full committee vote rated each recommendation	Used a proprietary evidence scale; full committee consensus or majority (by vote) decided whether/how to change existing recommendations	Used a proprietary evidence scale; the guideline working group unanimously rated each recommendation

The CTS guideline aimed to base recommendations on evidence in existing guidelines, using the ADAPTE process [40] to adapt existing recommendations, where applicable. If no relevant guidelines were found or if guidelines were more than one year old, they searched for systematic reviews; if no relevant reviews were found or if identified reviews’ literature searches were more than one year old, they used specific search terms to find randomized controlled trials.
For questions specifically surrounding the efficacy of a single inhaler of budesonide/formoterol as a reliever and a controller (SMART strategy), this search was extended to September 2011.
These were the search criteria used specifically for the pharmacological treatment section.
Questions were not provided in the publication nor on the GINA website.
AMSTAR denotes Assessment of Multiple Systematic Reviews; CMA denotes Canadian Medical Association; ED denotes emergency department; GIN denotes Guidelines International Network; GRADE denotes the Grading of Recommendations Assessment, Development and Evaluation; MERGE denotes Method for Evaluating Research and Guideline Evidence; RCT denotes randomized controlled trial.