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Critical Appraisal of Clinical Practice Guidelines Targeting Chronic Obstructive Pulmonary Disease
Yves Lacasse, MD, MSc;
Ivone Ferreira, MD;
Dina Brooks, PhD;
Toni Newman, BSc;
Roger S. Goldstein, MB, ChB
Arch Intern Med. 2001;161:69-74.
Background Chronic obstructive pulmonary disease (COPD) is so prevalent that the
endorsement of management strategies by professional organizations issuing
clinical practice guidelines (CPGs) will likely influence the clinical and
financial resources allocated to this condition.
Objectives To examine the content of and to critically appraise the CPGs targeting
COPD.
Methods We identified, through a MEDLINE search (from January 1990 to May 1999)
and contacts with experts and professional organizations, the CPGs for the
overall management of COPD. We assessed the guidelines according to an index
of quality measuring 3 dimensions: the rigor of development, the context and
content, and the extent to which the dissemination and implementation have
been addressed. The recommendations were also examined and compared.
Results Of the 15 CPGs we included, none was based on a systematic review of
the literature. Two were independently reviewed before their release, 1 included
strategies for dissemination and implementation, and 1 estimated the economic
implications associated with its recommendations. The recommendations were
often difficult to interpret (reviewers' agreement:  median, 0.41).
When unanimity existed regarding the benefits of a given management modality
(such as respiratory rehabilitation), discrepancies were often identified
in the application of the recommendation.
Conclusions The methodological quality of CPGs targeting COPD is limited, and there
are disparities among many of their recommendations. Despite there being several
CPGs worldwide, there is a need for an evidence-based summary of the literature
to serve as a resource for those who provide health care to individuals with
COPD.
From the Centre de Pneumologie de L'Hôpital Laval, Ste-Foy, Québec
(Dr Lacasse); the Departments of Medicine (Drs Ferreira and Goldstein) and
Physical Therapy (Drs Brooks and Goldstein), University of Toronto, Toronto,
Ontario; and the Department of Surgery, McMaster University, Hamilton, Ontario
(Ms Newman).
Corresponding author: Yves Lacasse, MD, MSc, Centre de Pneumologie
L'Hôpital Laval, 2725 Chemin Ste-Foy, Ste-Foy, Quebec, Canada G1V 4G5
(e-mail: Yves.Lacasse{at}med.ulaval.ca).
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