Canadian Pediatric Asthma Consensus Guidelines, 2003 (updated to December 2004): Introduction

Becker, Allan B.; Bérubé, Denis; Chad, Zave; Dolovich, Myrna; Ducharme, Francine M; D'Urzo, Tony; Ernst, Pierre; Ferguson, Alexander; Gillespie, Cathy; Kapur, Sandeep; Kovesi, Tom; Lyttle, Brian; Mazer, Bruce; Montgomery, Mark; Pedersen, Søren; Pianosi, Paul; Reisman, Joseph; Sears, Malcolm R.; Simons, Estelle; Spier, Sheldon; Thivierge, Robert; Watson, Wade; Zimmerman, Barry J.

doi:10.1503/cmaj.045064

Cited by 102 publications

(40 citation statements)

References 4 publications

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“…Other examples of English-language, strict evidence-based guidelines are the British Asthma Guidelines, which were revised most recently in November 2005 and are available on the Scottish Intercollegiate Guidelines Network website [11], and the Canadian Consensus Asthma Guidelines [12], which are pragmatic, evidence-based guidelines based on the same hierarchy of evidence as the British guidelines and were last revised in 2003 [13,14]. The International Primary Care Airways Group more recently developed a handbook to guide primary care physicians in the management of chronic airways disease [15].…”

Section: Overview Of Current Guidelinesmentioning

confidence: 99%

Breaking new ground: challenging existing asthma guidelines

Price

Thomas

2006

BMC Pulm Med

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BackgroundWhile we have international guidelines and various national guidelines for asthma diagnosis and management, asthma remains poorly controlled in many children and adults. In this paper we review the limitations of current asthma guidelines and describe important issues and remaining questions regarding asthma guidelines for use, particularly in primary care.DiscussionClinical practice guidelines based on evidence from randomized controlled trials are considered the most rigorous and accurate. Current evidence-based guidelines are written predominantly from the perspective of the patient with a clear-cut asthma diagnosis, however, and tend not to consider the heterogeneity of asthma or to accommodate individual patient variations in response to treatment or their needs, differences in practice settings, or local differences in availability and cost of therapies. The results of randomized controlled trials, which are designed to establish efficacy of treatment under ideal conditions, may not apply to 'real-world' clinical practice, where patients are unselected, monitoring is less frequent, and effectiveness – the benefit of treatment in routine clinical practice – is the most relevant outcome. Moreover, most guidelines see asthma in isolation rather than considering other factors that may impact on asthma and response to asthma therapy, particularly age, allergic rhinitis, cigarette smoking, adherence, and genetic factors. When these links are recognized, guidelines rarely provide practical recommendations for treatment in these scenarios. Finally, there is some evidence that general practitioners are not convinced of the applicability of asthma guidelines to their practice settings, especially when those writing the guidelines principally work in specialist practice.ConclusionDeveloping country-specific guidelines or, ideally, local guidelines could provide more practical solutions for asthma care and could account for regional factors that influence patient choice and adherence to therapy. Pragmatic clinical trials and well-designed observational trials are needed in addition to randomized controlled trials to assess real-world effectiveness of therapies, and such evidence needs also to be considered by guideline writers. Finally, practical tools to facilitate the diagnosis and assessment of asthma and factors responsible for poor control, such as associated allergic rhinitis, limited adherence, and smoking behavior, are needed to supplement treatment information provided in clinical practice guidelines for asthma.

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Section: Overview Of Current Guidelinesmentioning

confidence: 99%

Breaking new ground: challenging existing asthma guidelines

Price

Thomas

2006

BMC Pulm Med

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“…Clinicians need to determine whether the pathophysiological process is one such as bronchiolitis, asthma or pneumonia. The management of the aforementioned common conditions of childhood is dramatically different; bronchiolitis requiring supportive care,3 4 asthma requiring bronchodilators and anti-inflammatory therapy5 and pneumonia requiring antibiotics 6…”

Section: Introductionmentioning

confidence: 99%

Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze

et al. 2016

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“…Leukotriene receptor antagonists (LTRAs), such as montelukast, provide an alternative treatment for asthma patients who are not controlled or satisfied with ICS therapy [2,5-7,12]. Montelukast is an orally administered, once-daily LTRA that can be prescribed as monotherapy or in combination with other asthma medications, including ICSs, for the treatment of asthma.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of montelukast administered as monotherapy or in combination with inhaled corticosteroid in pediatric patients with uncontrolled asthma: a prospective cohort study

Bérubé

Djandji

Sampalis

et al. 2014

All Asth Clin Immun

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BackgroundAsthma is the most common chronic disease of childhood and a leading cause of childhood morbidity. The aim of the current study was to assess the effectiveness of montelukast administered as monotherapy or in combination with current inhaled corticosteroids (ICS) in pediatric patients with uncontrolled asthma as per the Canadian Asthma Consensus Guidelines.MethodsTwelve-week, multicentre, open-label, observational study. Primary effectiveness outcome was the proportion of patients achieving asthma control (Asthma Control Questionnaire (ACQ) score ≤0.75) at weeks 4 and 12.ResultsA total of 328 patients with uncontrolled asthma (ACQ > 0.75) were enrolled with mean ± SD age of 6.9 ± 3.4 years. Among these, 76 (23.2%) were treated with montelukast monotherapy and 252 (76.8%) with montelukast combined with ICS. By 4 weeks of treatment 61.3% and 52.9% of the patients in the monotherapy and combination group, respectively, achieved asthma control. These proportions increased to 75.0% and 70.9%, respectively, at 12 weeks. Within the monotherapy group, clinically significant improvements in the ACQ score (mean ± SD of 1.67 ± 0.69, 0.71 ± 0.70 and 0.50 ± 0.52 at baseline, 4 and 12 weeks, respectively; p < 0.001) and the PACQLQ score (mean ± SD of 5.34 ± 1.14, 6.32 ± 0.89 and 6.51 ± 0.85 at baseline, 4 and 12 weeks, respectively; p < 0.001) were observed. In the combination group, the mean ± SD ACQ score significantly improved from 2.02 ± 0.83 at baseline to 0.90 ± 0.86 at 4 weeks and 0.64 ± 0.86 at 12 weeks (p < 0.001), while the PACQLQ score improved from 4.42 ± 1.35 at baseline to 5.76 ± 1.30 at 4 weeks and 6.21 ± 1.03 at 12 weeks (p < 0.001). After a 12-week montelukast add-on therapy, 22.6% of patients reduced their ICS dosage. Similar results were observed among preschool- and school-aged patients.ConclusionsMontelukast as monotherapy or in combination with ICS represents an effective treatment strategy for achieving asthma control in pediatric patients and improving caregivers’ quality of life.Trial registrationThis study is registered at ClinicalTrial.gov: NCT00832455.

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Canadian Pediatric Asthma Consensus Guidelines, 2003 (updated to December 2004): Introduction

Cited by 102 publications

References 4 publications

Breaking new ground: challenging existing asthma guidelines

Breaking new ground: challenging existing asthma guidelines

Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze

Effectiveness of montelukast administered as monotherapy or in combination with inhaled corticosteroid in pediatric patients with uncontrolled asthma: a prospective cohort study

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