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1999 Evidence Based Review of the Australian Six Step Asthma

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1999 Evidence Based Review of the Australian Six Step Asthma FINAL REPORT 1999 EVIDENCE-BASED REVIEW OF THE AUSTRALIAN SIX STEP ASTHMA MANAGEMENT PLAN This document was written by Jennifer Coughlan, Amanda Wilson, Peter Gibson Department of Respiratory Medicine, John Hunter Hospital, NSW. NSW HEALTH DEPARTMENT © NSW Health Department 2000 This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusion of an acknowledgement of the source and no commercial usage or sale. The National Asthma Campaign has published this document with the permission of the NSW Health Department. February 2000 State Health Publication No: (CRCP) 990223 ISBN: 073473123X For further copies please contact: Health Promotion Strategies and Settings Unit Health Promotion Branch Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9537 Facsimile: (02) 9391 9540 ___________________________________________________________Executive Summary EXECUTIVE SUMMARY Background The Australian Asthma Management Plan was published in 1989 and was the first of many international, consensus-based asthma guidelines. International and NHMRC standards are currently calling for guidelines to be refined using the principles of evidence-based medicine. There is also a growing demand from medical practitioners and consumers to have access to evidence-based recommendations for therapy. The National Asthma Campaign and New South Wales Health collaborated with the intention of pursuing this goal in 1996-1997. A steering committee of experts in asthma, epidemiology and health policy was established to guide an evidence-based review of the Australian Asthma Management Plan. Beneficiaries Groups in Australia that will benefit from this work include: health policy makers, guideline writers, researchers, consumers, general practitioners, respiratory physicians, students and educators. Methods The first stage of this work involved generating questions relevant to the Australian Asthma Management Plan recommendations, the development and conduct of literature searches and review of abstracts for relevance. Questions were categorised according to two criteria: the existence of high quality evidence to answer the question and, the clinical relevance of the recommendation. Questions which were considered to be both clinically important and for which randomised controlled trial data were available, were given the highest priority for review. Results from previously conducted systematic reviews were consulted to answer questions. If there were no relevant systematic reviews available, then a Cochrane systematic review or a critically appraised recommendation was commenced. The Final Report This is a comprehensive report of the available evidence supporting the Australian Asthma Management Plan. It has been created as a reference document for the Health Department. This report is complemented by a summary publication in the form of a pocket-sized reference, and a website version (see the NSW Health site: www.health.nsw.gov.au and the National Asthma Campaign site: www.NationalAsthma.org.au). These smaller publications ii ___________________________________________________________Executive Summary will evolve as systematic reviews replace critically appraised recommendations, and as the evidence base grows through of the publication of additional randomised controlled trials, and publication of new systematic reviews on the Cochrane Database of Systematic Reviews. Achievements to Date There are six steps of the Australian Asthma Management Plan. Five of these refer to the maintenance treatment of asthma and are the subject of the reviews. Evidence pertaining to Steps 5 and 6 has been collected and collated. Steps 2, 3 and 4 are in progress. The process has involved: • The development and prioritisation of over 150 questions relevant to the Australian Asthma Management Plan. • The assessment of over 2000 abstracts for relevance to the questions. • The publication of five systematic reviews on the Cochrane Database of Systematic Reviews. (see Cochrane Systematic Reviews) • Through collaboration with the Cochrane Airways Group, systematic reviews have been generated, based on questions developed by this working group. (see Cochrane Systematic Reviews In Progress) • Twelve critically appraised recommendations have been conducted. (see Critically Appraised Recommendations) • A set of clinically important questions identifying areas of asthma management where Level 1 or 2 evidence is not available and research is needed. (see Research Questions) iii Table of Contents TABLE OF CONTENTS: EXECUTIVE SUMMARY..................................................................................................................................II AIMS......................................................................................................................................................................6 BACKGROUND....................................................................................................................................................6 NAC SIX STEP ASTHMA MANAGEMENT PLAN.........................................................................................7 LEVELS OF EVIDENCE.....................................................................................................................................8 METHODS............................................................................................................................................................8 Cochrane Collaboration Airways Group.......................................................................................................8 Steering Committee:.......................................................................................................................................9 Establishment of the Steering Committee......................................................................................................9 Contributors..................................................................................................................................................10 Available Resources.....................................................................................................................................10 Generation of Questions..............................................................................................................................10 Synthesis of the Literature...........................................................................................................................11 Critically Appraised Recommendations.......................................................................................................11 Cochrane Systematic Reviews and Meta-analyses.......................................................................................11 PRESENTATIONS.............................................................................................................................................12 THE FINAL REPORT........................................................................................................................................12 Target Audience...........................................................................................................................................12 Other Beneficiaries......................................................................................................................................12 SUMMARY OF PROJECT ACHIEVEMENTS..............................................................................................12 RESULTS.............................................................................................................................................................13 ACKNOWLEDGEMENTS................................................................................................................................13 DIAGNOSIS OF ASTHMA................................................................................................................................14 COCHRANE SYSTEMATIC REVIEWS....................................................................................................................14 CRITICALLY APPRAISED RECOMMENDATIONS...................................................................................................14 COCHRANE SYSTEMATIC REVIEWS IN PROGRESS..............................................................................................14 RESEARCH QUESTIONS......................................................................................................................................14 STEP 1: ASSESS ASTHMA SEVERITY..........................................................................................................15 COCHRANE SYSTEMATIC REVIEWS....................................................................................................................15 CRITICALLY APPRAISED RECOMMENDATIONS...................................................................................................15 COCHRANE SYSTEMATIC REVIEWS IN PROGRESS..............................................................................................15 RESEARCH QUESTIONS......................................................................................................................................15 STEP 2: ACHIEVE BEST LUNG FUNCTION................................................................................................16 COCHRANE SYSTEMATIC REVIEWS....................................................................................................................16
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