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- W1006420927 abstract "Introduction: International evidence-based pediatric asthma guidelines are often not used in clinical practice. In step 3 of pediatric asthma management some guidelines make clear choices for LABA were others give alternative options, but without being transparent in why choices are made. To enhance the usefulness of guidelines, the ATS has chosen GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) as the preferred methodology for rating the quality of evidence and strength of recommendations in clinical practice guidelines. Objective: Our aim was to develop transparent recommendations on step 3 of asthma management in children. Methods: We used GRADE to assess the quality of evidence and separately reported other considerations. Final recommendations were formulated on both evidence as well as the other considerations in cooperation with the Dutch Society of Pediatric Pulmonologists. Results: We found 7 RCTs comparing doubling the dose of ICS versus a combination of ICS and LABA and/or versus LTRA in children with symptomatic asthma despite normal ICS dose. According to GRADE, the quality of evidence was “moderate”, both treatments were effective and individual response could not be predicted. Other considerations included safety, convenience and costs. We suggest in children with symptomatic asthma despite ICS, to first double the dose of ICS. If not effective, a combination of ICS and LABA can be prescribed. In case of adverse effects or poor inhalation technique a LTRA can be prescribed. Conclusion: By using the GRADE approach together with other considerations clear recommendations for step 3 in asthma management were made. This approach might improve implementation." @default.
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- W1006420927 date "2011-09-01" @default.
- W1006420927 modified "2023-09-28" @default.
- W1006420927 title "Transparency in evidence-based pediatric asthma guidelines: GRADE and the other considerations" @default.
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