Create Content

Spaces

Rationale

Guidelines have increasingly become a familiar part of clinical practice. Since the Global Initiative for Asthma (GINA) was launched in 1983, as a programme to reduce asthma prevalence, morbidity and mortality, the organisation has published annual updates to its evidence-based asthma guidelines.1 Moreover, many countries have their own, asthma guidelines setting the evidence-based recommendations within their national context.

These guidelines serve a number of purposes. Guidelines help to raise the profile of a disease among patients, policymakers and clinicians. By offering recommendations to practitioners on asthma management, they provide a benchmark for optimal care, and can “raise the bar”, by encouraging the adoption of good practice from the perspective of a global patient population. However, guidelines have limitations in terms of shaping improvements in disease management and outcomes for individual patients. There is often a discrepancy between the evidence-based guideline, developed according to the principles of epidemiology and based on the results of randomised clinical trials (RCTs), and the clinical needs of an individual patient. Epidemiology and RCTs deal with large, patient populations sharing (often very stringent) exclusion and inclusion characteristics. The characteristics of an individual patient can fall outside the parameters covered by guideline treatment recommendations. Individuals present with multiple problems and co-morbidities, in addition to their asthma: RCTs and, therefore, guidelines, rarely address their particular needs.

In primary care, general practitioners have the difficult task of making a differential diagnosis from a series of varied signs and symptoms, thus guidelines most relevant to primary care should be based on the starting point of signs and symptoms. Current guidelines, often secondary-care driven, and based on the findings of RCTs of patients fulfilling clearly defined diagnostic criteria, may not resonate with primary care clinicians.

Since guidelines summarise the interventions that are, or are not, effective in populations, primary care physicians have to select from among the guideline’s recommendations those that will be useful for individual patients. Guidelines on treatment, based on RCTs, are derived from findings that may not apply to the “real-life” setting of primary care.

Against this background, the IPCRG has produced a series of position papers to address areas not covered in existing guidelines in context of the issues raised above. The papers are entitled: Trends in Asthma Prevalence and Presentation; Rhinitis and Asthma; Young Children with "wheeze" and Working with Patients to Improve Asthma Control. The papers have been produced by Onno Van Schayck, Chair of the IPCRG Guidelines Committee; Thys Van Der Molen, Chair of the IPCRG Asthma Guidelines working group; Anders Østrem, member of the Asthma Guidelines Group and Immediate Past President of the IPCRG; and David Price, Chair of the Rhinitis Guidelines working group and Chair of the IPCRG Research Sub-Committee. The authors gathered for a one-day meeting on 21 June, 2006 to discuss the development of these papers. Mike Thomas, member of the IPCRG Research Committee, provided additional input. The writing of the papers was supported by an unrestricted educational grant from Merck USA and performed by medical writer Rhonda Siddall and reviewed by Hilary Pinnock, Co-Lead of the IPCRG Education Committee. The opinions expressed in the papers are those of the IPCRG authors.

These papers are designed to bolster the work the IPCRG has already done to help inform the practice of primary care physicians working with patients with respiratory disease. This work includes the development of a handbook to guide primary care physicians in the management of chronic airways disease 2 and guidelines for primary care on the diagnosis of respiratory disease and the treatment of allergic rhinitis.3

References

1. http://www.ginasthma.com
2. http://www.ipagguide.org
3. http://www.sciencedirect.com/science/journal/14714418

IPCRG Authors

Anders Østrem is a general practitioner in Norway. He has been President of the IPCRG since 2004.
David Price is a part-time GP in Norwich, UK and General Practice Airways Group Professor of Primary Care Respiratory Medicine at the University of Aberdeen.
Mike Thomas is the Asthma UK Senior Research Fellow, a part-time GP and Hospital Practitioner in Respiratory Medicine. He is a member of the IPCRG research committee.
Thys van der Molen is Professor of Primary Care Respiratory Medicine in Groningen, The Netherlands. Thys is the founding President of the IPCRG.
Onno van Schayck is Professor of Preventive Medicine and Scientific Co-Director of Care and Public Health Research Institute (CAPHRI) of the Faculty of Medicine of the University of Maastricht.

 

 

 

IPCRG Asthma in Practice Position Papers

Rationale

Guidelines have increasingly become a familiar part of clinical practice. Since the Global Initiative for Asthma (GINA) was launched in 1983, as a programme to reduce asthma prevalence, morbidity and mortality, the organisation has published annual updates to its evidence-based asthma guidelines.1 Moreover, many countries have their own, asthma guidelines setting the evidence-based recommendations within their national context.

These guidelines serve a number of purposes. Guidelines help to raise the profile of a disease among patients, policymakers and clinicians. By offering recommendations to practitioners on asthma management, they provide a benchmark for optimal care, and can “raise the bar”, by encouraging the adoption of good practice from the perspective of a global patient population. However, guidelines have limitations in terms of shaping improvements in disease management and outcomes for individual patients. There is often a discrepancy between the evidence-based guideline, developed according to the principles of epidemiology and based on the results of randomised clinical trials (RCTs), and the clinical needs of an individual patient. Epidemiology and RCTs deal with large, patient populations sharing (often very stringent) exclusion and inclusion characteristics. The characteristics of an individual patient can fall outside the parameters covered by guideline treatment recommendations. Individuals present with multiple problems and co-morbidities, in addition to their asthma: RCTs and, therefore, guidelines, rarely address their particular needs.

In primary care, general practitioners have the difficult task of making a differential diagnosis from a series of varied signs and symptoms, thus guidelines most relevant to primary care should be based on the starting point of signs and symptoms. Current guidelines, often secondary-care driven, and based on the findings of RCTs of patients fulfilling clearly defined diagnostic criteria, may not resonate with primary care clinicians.

Since guidelines summarise the interventions that are, or are not, effective in populations, primary care physicians have to select from among the guideline’s recommendations those that will be useful for individual patients. Guidelines on treatment, based on RCTs, are derived from findings that may not apply to the “real-life” setting of primary care.

Against this background, the IPCRG has produced a series of position papers to address areas not covered in existing guidelines in context of the issues raised above. The papers are entitled: Trends in Asthma Prevalence and Presentation; Rhinitis and Asthma; Young Children with "wheeze" and Working with Patients to Improve Asthma Control. The papers have been produced by Onno Van Schayck, Chair of the IPCRG Guidelines Committee; Thys Van Der Molen, Chair of the IPCRG Asthma Guidelines working group; Anders Østrem, member of the Asthma Guidelines Group and Immediate Past President of the IPCRG; and David Price, Chair of the Rhinitis Guidelines working group and Chair of the IPCRG Research Sub-Committee. The authors gathered for a one-day meeting on 21 June, 2006 to discuss the development of these papers. Mike Thomas, member of the IPCRG Research Committee, provided additional input. The writing of the papers was supported by an unrestricted educational grant from Merck USA and performed by medical writer Rhonda Siddall and reviewed by Hilary Pinnock, Co-Lead of the IPCRG Education Committee. The opinions expressed in the papers are those of the IPCRG authors.

These papers are designed to bolster the work the IPCRG has already done to help inform the practice of primary care physicians working with patients with respiratory disease. This work includes the development of a handbook to guide primary care physicians in the management of chronic airways disease 2 and guidelines for primary care on the diagnosis of respiratory disease and the treatment of allergic rhinitis.3

References

1. http://www.ginasthma.com
2. http://www.ipagguide.org
3. http://www.sciencedirect.com/science/journal/14714418

IPCRG Authors

Anders Østrem is a general practitioner in Norway. He has been President of the IPCRG since 2004.
David Price is a part-time GP in Norwich, UK and General Practice Airways Group Professor of Primary Care Respiratory Medicine at the University of Aberdeen.
Mike Thomas is the Asthma UK Senior Research Fellow, a part-time GP and Hospital Practitioner in Respiratory Medicine. He is a member of the IPCRG research committee.
Thys van der Molen is Professor of Primary Care Respiratory Medicine in Groningen, The Netherlands. Thys is the founding President of the IPCRG.
Onno van Schayck is Professor of Preventive Medicine and Scientific Co-Director of Care and Public Health Research Institute (CAPHRI) of the Faculty of Medicine of the University of Maastricht.

Sub pages
  • No labels