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Chest. 2013 Aug;144(2):390-397. doi: 10.1378/chest.12-2005.

Quality assessment of asthma clinical practice guidelines: a systematic appraisal.

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Servicio de Neumonología, Centro Médico Docente la Trinidad y Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.
Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address:



The quality and potential impact of available clinical guidelines for asthma management have not been systematically evaluated. We, therefore, evaluated the quality of clinical practice guidelines (CPGs) for asthma.


We performed a systematic search of scientific literature published between 2000 and 2010 to identify and select CPGs related to asthma management. We searched guideline databases, guideline developers' websites, and the MEDLINE database of the US National Library of Medicine. Four independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument. We calculated the overall agreement among reviewers with the intraclass correlation coefficient (ICC).


Eighteen CPGs published between the years 2000 and 2010 were selected from a total of 1,005 references. The overall agreement among reviewers was moderate (ICC: 0.78; 95% CI, 0.62-0.90). The mean scores for each AGREE domain were: scope and purpose, 44.1% (range: 10.0%-79.0%); stakeholder involvement, 33.8% (range: 4.0%-66.0%); rigor of development, 32.4% (range: 8.0%-64.0%); clarity and presentation, 52.1% (range: 17.0%-85.0%); applicability, 21.1% (range: 3%-55%); and editorial independence, 25% (range: 0%-58%). None of the appraised guidelines had a score > 60% (recommended). One-half of the appraised guidelines were recommended with modifications (nine of 18) or not recommended (nine of 18) for use in clinical practice. We observed improvement over time in overall quality of the guidelines (P = .01; guidelines published in the period 2001-2006 vs 2007-2009).


The quality of guidelines for asthma care is low, although it has improved over time. Greater efforts are needed to provide high-quality guidelines that can be used as reliable tools for clinical decision-making in this field.

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