Preschool wheezing and asthma in children: a systematic review of guidelines and quality appraisal with the Agree II Instrument

Background Asthma-like symptoms in preschool children, such as wheezing and dyspnea,are common time-, and resource-consuming diagnostic and management challenges. Quality of wheezing and asthma recommendations vary. The purpose of this study, carried out by the EAACI Task Force for Preschool Wheeze, was to systematically review and assess the quality of guidelines for diagnosis and treatment of preschool wheezing and/or asthma. Methods The Cochrane Library, MEDLINE, and EMBASE were searched untilJune 2018. The methodological rigor, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Results We identified 26 guidelines. The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, whereas applicability and stakeholder involvement had the lowest.The scores (median) for individual domains were as follows: Score and purpose 86%; Stakeholder involvement 49%; Rigor of development 54%; Clarity of presentation 85%; Applicability 51%; and Editorial independence 63%. Conclusion Although several guidelines on asthma management in children are available; however, their quality varies. Additionally, there is a considerable gap in reliable recommendations on the management and treatment of non-asthmatic preschool wheeze.