In recent years, a multitude of practice guidelines, statements, position p
apers, and "best practices" have been promulgated for a number of disease e
ntities by a variety of medical societies and managed care organizations, I
n the case of asthma, for example, the National Heart, Lung, and Blood Inst
itute of the National Institutes of Health (NIH) initially published guidel
ines for the diagnosis and management of asthma in 1991; these recommendati
ons were updated in 1997. However, health-care providers have not widely an
d consistently adhered to these guidelines. Several recent publications sug
gest that this underutilization of the NIM asthma guidelines may in part be
related to a lack of understanding. This lack of understanding appears to
span the spectrum of physicians in private practice, physicians working in
health maintenance organizations, as well as university-affliated physician
s. Moreover, both primary-care physicians and "asthma specialists" share de
ficits in their knowledge base. To compound the problem, patients with asth
ma also demonstrate poor adherence to the guidelines. This poor adherence i
s evident irrespective of the patient's socioeconomic status. These types o
f data clearly indicate a need for further educational programs directed to
both physicians and patients. However, as with the development and promulg
ation of any practice guideline, physicians need to be convinced that there
exists compelling evidence from well-controlled clinical trials, for examp
le, or from evidence-based medicine, to substantiate implementation of thes
e guidelines.