Comparison of guidelines and self-management plans in asthma.

Since the rise in asthma mortality and morbidity, many guidelines and self-management plans have been published. Many of these guidelines and self-management plans are not, however, based on results of previous studies but on the opinion of experts. We compared the five most frequently cited asthma guidelines concerning treatment steps and self-management plans with special regard to peak expiratory flow (PEF)-guided plans in asthma. We also compared results of published studies with asthma-management in the context of the guidelines. Classification of asthma severity differed considerably between the guidelines. This was also true for PEF-guided patient self-management plans. Although there was agreement on the type of drug to be used, guidelines varied with respect to when to use the drug, the "best" strategy to increase the dose, and the maximum dose. The studies available on self-management do not make it possible to determine which part of the programme is most important or cost-effective. The latter is an important issue.