What Is New Since the Last (1999) Canadian Asthma Consensus Guidelines?

Abstract

The objective of the present document is to review the impact of new information on the recommendations made in the last (1999) Canadian Asthma Consensus Guidelines. It includes relevant published studies and observations or comments regarding what are considered to be the main issues in asthma management in children and adults in office, emergency department, hospital and clinical settings. Asthma is still insufficiently controlled in a large number of patients, and practice guidelines need to be integrated better with current care. This report re-emphasises the need for the following: objective measures of airflow obstruction to confirm the diagnosis of asthma suggested by the clinical evaluation; identification of contributing factors; and the establishment of a treatment plan to rapidly obtain and maintain optimal asthma control according to specific criteria. Recent publications support the essential role of asthma education and environmental control in asthma management. They further support the role of inhaled corticosteroids as the mainstay of anti-inflammatory therapy of asthma, and of both long acting beta2-agonists and leukotriene antagonists as effective means to improve asthma control when inhaled corticosteroids are insufficient. New developments, such as combination therapy, and recent major trials, such as the Children's Asthma Management Project (CAMP) study, are discussed.

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

“…A lthough Canadian guidelines for the diagnosis and management of asthma have been published over the last 15 years, [1][2][3][4] there has been little focus on issues relevant to asthma in the young child or on prevention strategies. Since the last update of the Canadian guidelines in 2001, 4 important issues and new studies focusing on asthma in early life have highlighted the need to incorporate this new information.…”

“…Since the last update of the Canadian guidelines in 2001, 4 important issues and new studies focusing on asthma in early life have highlighted the need to incorporate this new information. Reports pertaining to a number of issues published between 2000 and June 2003 were reviewed initially by small expert resource groups.…”

Management of acute asthma in adults in the emergency department: nonventilatory management

“…All health care professionals treating patients in the emergency setting should be skilled in crisis resource management, which involves good communication, delegation of tasks and frequent re-evaluation and reassessment of the patient. 97 Most of the recommendations for treating acute asthma that appeared in the 1996 guidelines of the Canadian Association of Emergency Physicians and the Canadian Thoracic Society 9 and in the 1999 Canadian Asthma Consensus Guidelines 10,11 remain unchanged. Here, we summarize new evidence on the potential role of inhaled corticosteroids in the management of acute asthma.…”

Asthma management: Are GINA guidelines appropriate for daily clinical practice?

“…From a practical perspective, addressing the level of control over asthma signs and symptoms is a reasonable approach with high validity for primary care physicians. [25] Symptom-based guidelines produced in Canada have improved primary care physicians' ability to manage asthma, although limited data are available [26][27][28]. In addition, the International Primary Care Respiratory Group is working on primary care-focused, symptom-based guidelines [20].…”