Overview of Results

 

The project focused on Level 1 and Level 2 evidence. Where the statement 'no evidence' is used in the following table, this should be read as 'no Level 1 or Level 2 evidence' was found. It should be noted that Level 3 or 4 evidence for the recommendation may exist. Where there is evidence of 'no effect', this should be interpreted as meaning that Level 1 or Level 2 evidence found the treatment to be ineffective.

 

Step 1.	Assess Asthma Severity	No Evidence
Step 2.	Achieve Best Lung Function
	Adults, FEV1 80% predicted, ICS < 800µg	Effective
	Adults, FEV1 80% predicted, ICS > 800µg	Effective
	Adults, FEV1 80% predicted, ICS < 800µg	Effective
	Adults, FEV1 80% predicted, ICS > 800µg	Effective
	ICS for children not responsive to SCG	Effective
Step 3.	Maintain Best Lung Function -  Identify and Avoid Trigger Factors
	House dust mite control measures	No Effect
	Reduction of cat dander by HEPA filter	No Effect
	Pollens, animals, moulds	No Evidence
	Influenza vaccinations	No Evidence
	Use of antibiotics without evidence of bacterial infection	No Effect
	Allergen immunotherapy	Effective
	Reflux therapy	No Effect
	Nedocromil sodium for exercise-induced asthma	Effective
	Avoidance of food allergens and additives	No Evidence
	Avoidance of drugs, emotional states, irritants, occupational sensitisers or temperature changes	No Evidence
Step 4.	Maintain Best Lung Function - Optimise Medication Program
	Metered dose inhalers and spacers vs nebulisers	Equivalent Effect
	Anti-cholinergic drugs for wheeze in children under 2 years	Effective
	Addition of eformoterol to ICS in mild-moderate asthma	Effective
	Methotrexate as a steroid-sparing agent	Effective(with risks)
	Long-acting beta-agonists  vs  theophylline	Effective (fewer risks)
	Alternatives to Pharmacotherapy
	Physical training	No Effect
	Acupuncture	No Evidence
	Family therapy as an adjunct to medication	Effective
	Homeopathy	No Evidence
	Speleotherapy	No Evidence
	Primary prevention of ingested allergens	No Long-term Effect
Step 5.	Develop an Action Plan
	Provision of an individualised written action plan	Effective
Step 6.	Educate and Review Regularly
	Provision of information alone (structured or unstructured  program)	No Effect
	Information alone in the emergency department	Possibly Effective
	Information coupled with self-monitoring, regular review and a written action plan	Effective
	Doctor-managed vs self-managed asthma	Equivalent Effect