Guidelines in pulmonary medicine - A 25-year profile

Objective: We attempted to identify clinical practice guideline and pathway articles in the area of pulmonary medicine published in peer-reviewed jour nals since 1974. Design: Review. Data sources: MEDLINE, the Cochrane Database, Best: Evidence, and Abstracts of Clinical Care! Guidelines from January 1974 to December 1998. Study selection: All articles contained relevant search terms for pulmonary topics and were included irrespective of setting (primary or specialty, in patient or outpatient). Controlled and uncontrolled trials as well as obser vational studies and consensus opinion/statements were all identified. The articles were stratified by design as well as by pulmonary topic. Data extraction: Limited data on study type, study focus, year of publicati on, and results of study were abstracted. Results: Our criteria yielded 271 articles, including 115 consensus stateme nts and expert opinion guidelines; 30 controlled studies, meta-analyses, or systematic reviews; and 126 uncontrolled trials and observational studies. Of these, 82 articles (30.3%) related to asthma, 46 articles (17.0%) relat ed to COPD, and 36 articles (13.3%) related to pneumonia, In addition, we t racked the increasing publication of all guideline-related pulmonary articl es; randomized, controlled trials (RCTs); systematic reviews; and consensus statements by year for the past 25 years. Conclusion: Pulmonary guidelines are increasingly published in peer-reviewe d journals, but few are tested clinically in RCTs. There is continued relia nce on consensus statements and expert opinion. Pulmonary guideline publica tions have continued to dramatically increase in number and in importance s ince 1974, both on the local level and internationally.