Physiotherapy interventions in the BTS guidelines on the management of asthma (2011): a need for change?

Updates to the British Thoracic Society (BTS) asthma guidelines have been recently highlighted by Turner and colleagues. 1 2 To our concern, the content on physiotherapy interventions has not been revised or updated since the 2006 version. We reviewed the contents of the new BTS guidelines relevant for physiotherapists. The timescale for literature search indicates that the relevant section was last updated in February 2006, with coverage in Medline extending from 1996 to 2005. Thus, we searched PubMed for English language papers published between January 2006 and December 2010 and found 32 indexed as randomised controlled trials. In the Cochrane Database of Systematic Reviews we found updates or revisions to all cited documents, with those updated in 2004 and 2005 and not quoted in the guideline. A corresponding document, not referred to in the BTS guidelines, the joint BTS and the Association of Chartered Physiotherapists in Respiratory Care (ACPRC) Guidelines for the Physiotherapy Management of the Adult, Medical, Spontaneously Breathing Patient, with a section on physiotherapy interventions in adults with asthma, was published in Thorax in 2009. 3 The authors searched multiple databases (with date limits ranging from May 2005 to January 2006) and their recommendations differ, to some extent, from those provided in the BTS guidelines. This causes some confusion as to which guidelines should be considered. The terminology, levels of evidence and grades of recommendations for physiotherapy interventions, reported in both documents, are compared below in the table 1. According to the BTS asthma guidelines 'evidence that non-pharmacological management is effective can be difficult to obtain and more studies are required'. 1 However, this statement seems to be not fully relevant in the case of physiotherapy interventions. Evidence-based practice is a priority in the development of physiotherapy. 4 Numerous, increasingly rigorous studies have been published since the early 2000s. In 2010, 24 Cochrane reviews on non-medical management of asthma were available , including six reviews regarding physical therapies. 5 The updated Cochrane reviews, not reported in the BTS guideline, do not generally provide new or changed conclusions; however, it is quite debatable why the updates have not been provided in the guidelines since 2004.