Objective: We attempted to identify clinical practice
guideline and pathway articles in the area of pulmonary medicine
published in peer-reviewed journals since 1974.
Data sources: MEDLINE, the
Cochrane Database, Best Evidence, and Abstracts of Clinical Care
Guidelines from January 1974 to December 1998.
selection: All articles contained relevant search terms for
pulmonary topics and were included irrespective of setting (primary or
specialty, inpatient or outpatient). Controlled and uncontrolled trials
as well as observational studies and consensus opinion/statements were
all identified. The articles were stratified by design as well as by
Data extraction: Limited data on
study type, study focus, year of publication, and results of study were
Results: Our criteria yielded 271
articles, including 115 consensus statements 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%)
related to COPD, and 36 articles (13.3%) related to pneumonia. In
addition, we tracked the increasing publication of all
guideline-related pulmonary articles; randomized, controlled trials
(RCTs); systematic reviews; and consensus statements by year for the
past 25 years.
Conclusion: Pulmonary guidelines
are increasingly published in peer-reviewed journals, but few are
tested clinically in RCTs. There is continued reliance on consensus
statements and expert opinion. Pulmonary guideline publications have
continued to dramatically increase in number and in importance since
1974, both on the local level and internationally.