Applying GRADE for diagnosis revealed methodological challenges: an illustrative example for guideline developers.

Objective: To identify challenges in the application of GRADE for diagnosis when assessing the certainty of evidence in the test-treatment strategy (diagnostic accuracy, test burden, management effectiveness, natural course, linked evidence) in an illustrative example and to propose solutions to these challenges.

Study Design And Setting: A case study in applying GRADE for diagnosis that looked at the added value of IgE for diagnosing allergic rhinitis.

Results: Evaluation of the full test-treatment strategy showed a lack of (high-quality) evidence for all elements.

Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review.

Objective: Because most children with asthma now use inhaled corticosteroids (ICS), the added benefit of immunotherapy in asthmatic children needs to be examined. We re-assessed the effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) in childhood asthma treatment focusing on studies with patient-relevant outcome measures and children using ICS.

Methods: We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to systematically search and appraise the evidence using predefined critical patient-relevant outcomes (asthma symptoms, asthma control and exacerbations).

Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma.

Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.

[Dutch College of General Practitioners' practice guideline 'Asthma in children'].

In children < 6 years characteristic asthma patterns are often lacking and the diagnosis cannot be objectified. For this reason 'episodic expiratory wheezing' is the preferred diagnosis. In children ≥ 6 years asthma is diagnosed on the basis of symptoms; if there is doubt spirometry may be helpful.

Problematic severe asthma in children treated at high altitude: tapering the dose while improving control.

Background: Multidisciplinary treatment at high altitude is a possible treatment option for problematic severe asthma (PSA) in children. This management can result in the tapering of inhaled corticosteroids.

Aim: Our aim was to analyze the effect of multidisciplinary treatment at high altitude, notably the ability to taper corticosteroids.