Article Text
Abstract
Rationale There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines.
Objectives To describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographic regions.
Methods Observational study of guidelines for the management of acute paediatric asthma from institutions across a global collaboration of six regional paediatric emergency research networks.
Measurements and main results 158 guidelines were identified. Half provided recommendations for at least two age groups, and most guidelines provided treatment recommendations according to asthma severity.
There were consistent recommendations for the use of inhaled short-acting beta-agonists and systemic corticosteroids. Inhaled anticholinergic therapy was recommended in most guidelines for severe and critical asthma, but there were inconsistent recommendations for its use in mild and moderate exacerbations. Other inhaled therapies such as helium-oxygen mixture (Heliox) and nebulised magnesium were inconsistently recommended for severe and critical illness.
Parenteral bronchodilator therapy and epinephrine were mostly reserved for severe and critical asthma, with intravenous magnesium most recommended. There were regional differences in the use of other parenteral bronchodilators, particularly aminophylline.
Guideline quality assessment identified high ratings for clarity of presentation, scope and purpose, but low ratings for stakeholder involvement, rigour of development, applicability and editorial independence.
Conclusions Current guidelines for the management of acute paediatric asthma exacerbations have substantial deficits in important quality domains and provide limited and inconsistent guidance for severe exacerbations.
- respiratory medicine
- emergency care
- paediatrics
Data availability statement
Data are available upon reasonable request. Data are available on reasonable request. De-identified data will be available for sharing from 1 January 2025. Any data access requests should be sent to SC (simon.craig@monash.edu) and should include a proposal from the individual or organisation regarding their plan for use of the data.The study team will review the request and consider the scientific merit of the proposed use of the data, and the legal, regulatory and ethical issues pertinent to the request. Presuming all constraints are addressed, the data will be shared using a secure file transfer platform.
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Data availability statement
Data are available upon reasonable request. Data are available on reasonable request. De-identified data will be available for sharing from 1 January 2025. Any data access requests should be sent to SC (simon.craig@monash.edu) and should include a proposal from the individual or organisation regarding their plan for use of the data.The study team will review the request and consider the scientific merit of the proposed use of the data, and the legal, regulatory and ethical issues pertinent to the request. Presuming all constraints are addressed, the data will be shared using a secure file transfer platform.
Footnotes
X @DrSimonCraig, @JavierBenitoF, @RoberVelasco80, @mdlyttle, @damian_roland, @adriyock
Contributors SC, FEB, CP, SD and AG identified the research question. SC was responsible for the study design and research protocol, with input from all authors. JB, RV, MC and SC obtained data supervised data extraction and analysis. SC was responsible for statistical analysis. SC drafted the initial manuscript. All authors contributed equally to writing, reviewing and editing the manuscript. All authors provided comments on the drafts and have read and approved the final version of the article. All authors had full access to all of the data (including statistical reports and tables) at the conclusion of the study and take responsibility for the integrity of the data and the accuracy of the data analysis. SC is the guarantor for the paper, accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.
Funding This work is supported by the NHMRC Centre of Research Excellence in Paediatric Emergency Medicine (GNT1171228), Canberra, Australia. SC’s contribution was funded by the Thoracic Society of Australia and New Zealand and National Asthma Council Fellowship, 2020 and the Australasian College for Emergency Medicine Foundation Al Spilman Early Career Research Grant 2017. SDs time was in part funded by Cure Kids New Zealand. FEB’s time was funded by an NHMRC Investigator Leadership grant (GNT2017605) and the Royal Children’s Hospital Foundation, Parkville, Australia.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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