哮喘联盟

   摘要
   目的：支持或反对成人哮喘生理治疗干预的证据尚不明确，不同临床实践指南之间仍存在矛盾。我们比较了以下两个主要的临床实践指南对成人哮喘生理治疗的推荐程度：全球哮喘防治创议(GINA 2011)和英国胸科协会与呼吸护理特许物理治疗医师协会(BTS/ACPRC 2009)。
   方法：运用AGREEII工具评价指南方法学上是否严格，运用AMSTAR工具和PEDro量表评价所分析文献中系统综述和临床试验的方法学质量。另外，比较了已分析部分的参考文献列表，已建立包括初级和次级研究在内的交集部分。
   结果：我们观察到两个指南在文献的选择上没有相同之处。BTS指南中入选的18个研究仅有2个被GINA纳入。GINA制定者为何不参考BTS纳入文献的原因不甚明确。三名独立调查员表示AGREE II评价BTS/ACPRC 在所有方面得分均高于GINA 指南。
   结论：两大指南在内容和发展历程上的显著差异提示需要更频繁和细致的更新，建议GINA读者关注BTS/ ACPRC，因为后者涉及了具体和更多的哮喘生理治疗干预。

（苏楠 审校）
J Asthma. 2013 Apr 2. [Epub ahead of print]
 

Physiotherapy in asthma - seeking consensus.
 

Nowobilski R, Plaszewski M, Wloch T, Mika P, Gajewski P, Brożek JL.
 

Abstract
OBJECTIVE：The evidence base for or against physiotherapy interventions in adults with asthma remains ambiguous, and there are discrepancies between different clinical practice guidelines. We evaluated the level of agreement between the recommendations about physiotherapy for adults with asthma in two major clinical practice guidelines: the Global Initiative for Asthma (GINA 2011) and the British Thoracic Society and the Association of Chartered Physiotherapists in Respiratory Care (BTS/ACPRC 2009).
METHODS：We used the AGREE II instrument to assess the methodological rigour of the guideline development, the AMSTAR tool and the PEDro scale to assess the methodological quality of systematic reviews and clinical trials included in the analysed documents. Additionally, we compared the reference lists of the analysed sections to establish the overlap in included primary and secondary studies.
RESULTS：We observed no agreement between the two guidelines in the choice of source research articles. Only 2 studies out of 18 used in BTS guidelines were used in the GINA. The reason why GINA developers did not use the body of evidence included in BTS is not clear. Three independent investigators indicated higher scores in all domains of the AGREE II in the BTS/ACPRC document in comparison with the GINA guidelines.
CONCLUSIONS：The significant differences in the content and development processes of the examined sections of the two guidelines suggest the need for more frequent and careful updating or directing the readers of the GINA to the BTS/ ACPRC, a guideline addressing specifically and more comprehensively physiotherapy interventions in asthma.

J Asthma. 2013 Apr 2. [Epub ahead of print]