title: Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults.
abstract: BACKGROUND
  In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and⁄or gaps in the previous guidelines.
  
  
  METHODS
  Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations.
  
  
  RESULTS
  The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified.
  
  
  CONCLUSIONS
  The present clinical practice guideline is the first update of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee's new guideline development process. Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide updates reflecting new evidence.
authors.forename: M Diane
authors.initials: MD
authors.lastname: Lougheed
authors.forename: Catherine
authors.initials: C
authors.lastname: Lemiere
authors.forename: Francine M
authors.initials: FM
authors.lastname: Ducharme
authors.forename: Chris
authors.initials: C
authors.lastname: Licskai
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Dell
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Richard
authors.initials: R
authors.lastname: Leigh
authors.forename: Wade
authors.initials: W
authors.lastname: Watson
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D002170:Canada; D002648:Child; D004359:Drug Therapy, Combination; D006801:Humans; D012138:Respiratory Therapy; D012955:Societies, Medical; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000893:Anti-Inflammatory Agents