European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years
Por:
Gaillard, EA, Kuehni, CE, Turner, S, Goutaki, M, Holden, KA, de Jong, CCM, Lex, C, Lo, DKH, Lucas, JS, Midulla, F, Mozun, R, Piacentini, G, Rigau, D, Rottier, B, Thomas, M, Tonia, T, Usemann, J, Yilmaz, O, Zacharasiewicz, A, Moeller, A
Publicada:
4 nov 2021
Resumen:
Background Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children.
Methods A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
Results The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Conclusion Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
Filiaciones:
Gaillard, EA:
Univ Leicester, Dept Resp Sci, Leicester NIHR Biomed Res Ctr Resp theme, Leicester, Leics, England
Univ Hosp Leicester, Leicester Childrens Hosp, Dept Paediat Resp Med, Leicester, Leics, England
Kuehni, CE:
Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
Univ Bern, Childrens Univ, Childrens Hosp, Paediat Resp Med, Bern, Switzerland
Turner, S:
Univ Aberdeen, Child Hlth, Aberdeen, Scotland
Goutaki, M:
Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
Univ Bern, Childrens Univ, Childrens Hosp, Paediat Resp Med, Bern, Switzerland
Holden, KA:
Univ Leicester, Dept Resp Sci, Leicester NIHR Biomed Res Ctr Resp theme, Leicester, Leics, England
de Jong, CCM:
Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
Lex, C:
Univ Med Ctr Goettingen, Dept Paediat Cardiol Intens Care Med & Neonatol P, Gottingen, Germany
Lo, DKH:
Univ Leicester, Dept Resp Sci, Leicester NIHR Biomed Res Ctr Resp theme, Leicester, Leics, England
Univ Hosp Leicester, Leicester Childrens Hosp, Dept Paediat Resp Med, Leicester, Leics, England
Lucas, JS:
Univ Hosp Southampton NHS Fdn Trust, Natl Inst Hlth Res, Primary Ciliary Dyskinesia Ctr, Southampton Biomed Res Ctr, Southampton, Hants, England
Univ Southampton, Fac Med, Sch Clin & Expt Med, Southampton, Hants, England
Midulla, F:
Sapienza Univ Rome, Maternal Sci Dept, Rome, Italy
Mozun, R:
Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
Piacentini, G:
Univ Verona, Dept Surg Sci Dent Gynaecol & Pediat, Verona, Italy
Rigau, D:
Iberoamer Cochrane Ctr, Barcelona, Spain
Rottier, B:
Univ Groningen, Univ Med Ctr Groningen, Beatrix Childrens Hosp, Dept Paediat Pulmonol & Paediat Allergol, Groningen, Netherlands
Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
Groningen Res Inst Asthma & COPD, GRIAC, Groningen, Netherlands
Thomas, M:
Univ Southampton, Primary Care Populat Sci & Med Educ PPM, Fac Med, Southampton, Hants, England
Tonia, T:
Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
Usemann, J:
Univ Childrens Hosp Basel UKBB, Basel, Switzerland
Univ Childrens Hosp Zurich, Div Resp Med, Zurich, Switzerland
Childhood Res Ctr, Zurich, Switzerland
Yilmaz, O:
Celal Bayar Univ, Dept Pediat Allergy & Pulmonol, Manisa, Turkey
Zacharasiewicz, A:
Univ Vienna, Teaching Hosp, Wilhelminenspital, Dept Pediat & Adolescent Med, Vienna, Austria
Moeller, A:
Univ Childrens Hosp Zurich, Div Resp Med, Zurich, Switzerland
Childhood Res Ctr, Zurich, Switzerland
Green Submitted, Bronze
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