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Editor - Modern drug treatment of chronic asthma. Should opinion
based or evidence based guidelines be used in clinical practice?
Brian Lipworth's fortnightly review: "Modern drug treatment of
chronic asthma" (1) does not discuss the North of England evidence-based
guideline for asthma (2). He admits that this review is based on personal,
long standing, clinical and research interest in the management of allergy
and asthma. He states that the latest guidelines are out of date, e.g. on
leukotriene antagonists. He then refers to the British guidelines on
asthma, published in Thorax (3). The trouble with the evidence based
guidelines series from the North of
England group is that they are laborious to produce and easily out dated
when looking at effectiveness of various therapeutic interventions. For
example, the dementia guideline was criticised on its arguments against
the
use of donepezil, being outdated because the literature search ended in
1996 and the guideline was published in September 1998. Although all
important decision options and outcomes in Lipworth's paper were clearly
specified, the evidence relevant to each decision option was not validated
and combined in a sensible and explicit way- rather it was
compiled on the basis of his specialty knowledge, which may represent a
heavily biased, and opinion-based, approach.
His advice tries to accommodate the new class of asthma drugs, the
leukotriene antagonists, which may have an important impact on management
in future. Although he says there is a need for more studies before this
new class of asthma drugs may be considered, he argues favourably for
them. He very frankly declares his and his spouse's conflicts of interest
at the end of the paper, but we still wonder where we should place his
paper in our (outdated) personal knowledge. We need to stick to systematic
approaches when producing guidelines and overviews, not only personal
experience. We would like to argue for a more
measured and circumspect approach to the introduction of new drugs.
Yours sincerely
Paul Kamill MB BS, MPH, MRCGP
Rooley Lane Medical Centre
Bradford
West Yorkshire
BD4 7SS
Atle Klovning, MD, GP/Research Fellow,
Div. for General Practice
University of Bergen
Ulriksdal 8C, N-5009
Bergen
Norway
Conflicts of interest: None.
1 Lipworth BJ. Modern drug treatment of chronic asthma. BMJ
1999;318(7180):380-384.
2 North of England Asthma Guideline Development Group. North of
England evidence based guidelines development project: summary version of
evidence based guideline for the primary care management of asthma in
adults. BMJ 1996;312:762-6.
3 Asthma in adults and schoolchildren. The General Practitioner in Asthma
Group, the British Association of Accident and Emergency Medicine, the
British
Paediatric Respiratory Society and the Royal College of Paediatrics and
Child Health. Thorax 1997;52 Suppl 1:S2-8, S11-5, S20-1.
Should opinion based or evidence based guidelines be used in clinical practice?
Editor - Modern drug treatment of chronic asthma. Should opinion
based or evidence based guidelines be used in clinical practice?
Brian Lipworth's fortnightly review: "Modern drug treatment of
chronic asthma" (1) does not discuss the North of England evidence-based
guideline for asthma (2). He admits that this review is based on personal,
long standing, clinical and research interest in the management of allergy
and asthma. He states that the latest guidelines are out of date, e.g. on
leukotriene antagonists. He then refers to the British guidelines on
asthma, published in Thorax (3). The trouble with the evidence based
guidelines series from the North of
England group is that they are laborious to produce and easily out dated
when looking at effectiveness of various therapeutic interventions. For
example, the dementia guideline was criticised on its arguments against
the
use of donepezil, being outdated because the literature search ended in
1996 and the guideline was published in September 1998. Although all
important decision options and outcomes in Lipworth's paper were clearly
specified, the evidence relevant to each decision option was not validated
and combined in a sensible and explicit way- rather it was
compiled on the basis of his specialty knowledge, which may represent a
heavily biased, and opinion-based, approach.
His advice tries to accommodate the new class of asthma drugs, the
leukotriene antagonists, which may have an important impact on management
in future. Although he says there is a need for more studies before this
new class of asthma drugs may be considered, he argues favourably for
them. He very frankly declares his and his spouse's conflicts of interest
at the end of the paper, but we still wonder where we should place his
paper in our (outdated) personal knowledge. We need to stick to systematic
approaches when producing guidelines and overviews, not only personal
experience. We would like to argue for a more
measured and circumspect approach to the introduction of new drugs.
Yours sincerely
Paul Kamill MB BS, MPH, MRCGP
Rooley Lane Medical Centre
Bradford
West Yorkshire
BD4 7SS
Atle Klovning, MD, GP/Research Fellow,
Div. for General Practice
University of Bergen
Ulriksdal 8C, N-5009
Bergen
Norway
Conflicts of interest: None.
1 Lipworth BJ. Modern drug treatment of chronic asthma. BMJ
1999;318(7180):380-384.
2 North of England Asthma Guideline Development Group. North of
England evidence based guidelines development project: summary version of
evidence based guideline for the primary care management of asthma in
adults. BMJ 1996;312:762-6.
3 Asthma in adults and schoolchildren. The General Practitioner in Asthma
Group, the British Association of Accident and Emergency Medicine, the
British
Paediatric Respiratory Society and the Royal College of Paediatrics and
Child Health. Thorax 1997;52 Suppl 1:S2-8, S11-5, S20-1.
Competing interests: No competing interests