Despite the success of asthma management guidelines so far, increased efforts are required to improve adherence to guidelines and promote the delivery of quality asthma care.

THE ROLE OF GUIDELINES IN MANAGING ASTHMA

The role of guidelines

The WHO reports that lack of awareness probably represents the most important barrier to progress in the diagnosis, treatment and care of individuals with non-communicable diseases, including asthma. Asthma management guidelines encourage awareness and play an important role in patient care, focusing on the assessment of asthma symptoms and their severity, and recommendations for effective medicines in children and adults, as well as non-pharmacological measures.

Who determines the guidelines?

When the first guidelines were created in the late 1980s, it was almost uniform that pharmaceutical companies sponsored the consensus meetings. In more recent times, where there are alternative sources of funding available, in many cases doctors are choosing to create evidence–based guidelines, without the involvement of pharmaceutical companies in any aspect of the process.

Some groups developing asthma management guidelines have been instrumental in constraining the pharmaceutical industry, where attempts have been made to broaden the therapeutic indications for a particular type of medication. Others have been able to discuss recommendations within guidelines where these have not been based on evidence.

However, asthma prevalence is increasing, and the global economic burden is substantial. Despite the success of asthma management guidelines so far, increased efforts are required to improve adherence and promote recognition of quality asthma care. The use of asthma guidelines should be encouraged to reduce hospital admissions and improve asthma control for the benefit of both patients and the health systems that serve them.

The ISAAC survey of national guidelines 2011

To identify countries with existing asthma management guidelines for children and adults, ISAAC canvassed its collaborators from the 105 countries that participated in Phases One, Two and Three. They were asked if they had guidelines for children, for adults and also if the development of the guidelines had been supported with pharmaceutical company funding.
(see Maps, Data, Resources: Appendix Table 2)

There was an 88% (92/105) response rate to the survey. Of the 92 countries that responded, 69 (75%) said they used asthma management guidelines for children, and 71 (77%) said they used them for adults.

For the children, 58/69 countries (84%) had their own national asthma management guidelines. Of these, 34 (59%) did not receive pharmaceutical company financial support, 14 (24%) said they did and 4 countries did not know if they had received pharmaceutical company financial support or not.

For the adults, 61/71 countries (87%) reported they had their own national asthma management guidelines. Of these 28 (46%) did not receive pharmaceutical company financial support, 18 (29%) said they did, and 8 countries did not know if they had received pharmaceutical company financial support or not. The results are shown in Figure 1.

Clearly, asthma management guidelines appear to be an important part of medical practice in the majority of countries. It is encouraging that, in the 58 countries with guidelines for children, more than half (59%) were developed without pharmaceutical company funding. While the percentage is lower (46%) in the 61 countries with guidelines for adults, this is still an improvement over the situation when guidelines were first introduced in the 1980s. Independently developed guidelines avoid any perception of influence by the pharmaceutical industry regarding branding and allow the most appropriate therapeutic drugs to be recommended. They can also be regularly updated based on new evidence.

Asthma management guidelines are an essential part of efforts to provide access to effective, appropriate drug therapy and management.

-Philippa Ellwood, Innes Asher, Eamon Ellwood

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