Nov 6, 2008
No compelling need for change to the DMP for asthma and COPD
However, search for new or updated guidelines identifies areas that could be amended and specified
On 6 November 2008, the German Institute for Quality and Efficiency in Health Care (IQWiG) presented the results of a search for new or updated evidence-based clinical practice guidelines (CPGs) on chronic obstructive pulmonary disease (COPD) and asthma. The aim of the report was to identify key recommendations from current CPGs of high methodological quality that could be relevant to the planned revision of the disease management programme (DMP) for asthma and COPD. According to the results, there is no compelling need for change to any section of the DMP for asthma and COPD. However, various areas were identified that could be amended and specified.
Evidence documented in detail
The German Federal Joint Committee commissioned IQWiG to systematically search for new or updated CPGs, assess their methodological quality, and compile relevant recommendations on diagnostic, therapeutic, and rehabilitative measures in patients with asthma and COPD. In addition, IQWiG documented the scientific evidence provided in the CPGs for these recommendations. However, the evidence provided was not reassessed; this is where IQWiG's CPG assessments differ from its benefit assessments.
No contradictions between the DMP for asthma and COPD and current recommendations
A total of 17 high-quality CPGs developed for the treatment of asthma and 15 on COPD were included. As the assessment showed, the recommendations in the CPGs were largely consistent with those in the DMP: there were no contradictions of content, nor did IQWiG find relevant new information in the CPGs that would have compellingly required a modification of the DMP. However, the current CPGs address several health care issues in a more detailed manner than the DMP does.
The IQWiG report sees a potential need for change primarily in the form of an amendment and specification of the DMP. For asthma, this particularly refers to the presentation of drug therapy (orientation towards the degree of asthma severity or the degree of asthma symptom control). In addition, the issue of acute asthma attacks could be considered more intensively in the DMP requirements. For COPD, IQWiG sees a potential need for modifications, particularly regarding the relevance of reversibility testing in COPD diagnosis. Moreover, in particular the recommendations on the procedures for acute exacerbations and the administration of systemic corticosteroids could be presented in a more differentiated manner in the DMP.
Procedure of report production
IQWiG published the preliminary results (preliminary report) at the end of March 2008 and invited interested parties to submit comments. As the written comments received did not contain unclear aspects and no questions remained open, the Institute dispensed with an oral debate. After the end of the hearing procedure, the preliminary report was revised and the final report sent to the contracting agency (the Federal Joint Committee) at the beginning of September 2008. A documentation of the written comments was published in a separate document simultaneously with the final report.
The executive summary provides an overview of the background, methods, and further results of the final report.
Contact: Tel. ++49 (0)221-35685-0, info@iqwig.de