Methodology

Development of the Australian Asthma Handbook Version 3.0, published in September 2025 by National Asthma Council Australia (NAC), involved both a major revision of clinical guidance and a complete redesign of the website.

Website development

The NAC commissioned an analysis of website user experience, conducted across 2023–2024, which included a user survey, focus groups, and interviews with a diverse selection of users including GPs, nurses and pharmacists. Research involved GP participants searching the previous edition of the Handbook to answer specific clinical questions, then reporting on the ease or difficulty finding the relevant information.

The design for the new website incorporated user feedback indicating the need to maintain a comprehensive clinical scope while simplifying the web structure, navigation and interface.

Development of clinical guidance

Guidelines Committee

Development of recommendations and clinical information was overseen by the NAC’s Guidelines Committee, comprising GPs, nurses, pharmacists and respiratory physicians. 

See below for the full list of contributors to Australian Asthma Handbook. 

Management of competing interests

In accordance with NAC policy, Guidelines Committee members and other contributors completed a detailed declaration of interests, including financial interests and significant connection to source materials, such as direct involvement in the development of existing guidelines or in research contributing to evidence cited in source guidelines. Potential conflicts were managed according to NAC policy.

A statement of contributors’ interests is published for each edition of the Australian Asthma Handbook.

Scoping

Topics and clinical questions were identified from the previous online version of the Handbook and topics proposed by Guidelines Committee members.

Core sections on asthma diagnosis and management underwent a full revision, following the approach to evidence synthesis described below. Related clinical topics underwent interim update and are scheduled for future update.

Evidence synthesis

Approach: adaptation of existing guidelines

The Guidelines Committee Chair, in consultation with the Clinical Executive Lead, Chief Executive Officer and NAC Board, determined that this major revision of the evidence and clinical guidance should be based on adaptation of existing evidence-based clinical practice guidelines. This process involved identifying candidate evidence-based asthma guidelines and using a structured process to select a small set of source guidelines.

The NAC Board determined that the Handbook should be adapted from more than one existing asthma guideline in the expectation that the currency of evidence would differ between topics, to minimise unintended bias by ensuring that the Guidelines Committee considered a range of approaches to synthesising and interpretating clinical evidence.

Selection of source guidelines

The Clinical Executive Lead identified 18 guidelines in English (developed by 12 organisations) based on synthesis of evidence. From this set, 5 candidate guidelines were selected through an initial assessment of the currency of evidence and the relevance of the populations and clinical topics covered.

Three independent reviewers assessed each candidate guideline using a structured assessment tool of 13 criteria, based on AGREE II [AGREE 2013] and on NHMRC guidance on selecting existing guidelines for adaptation. [NHMRC 2023]

This process resulted in the selection of four source guidelines accepted by the Guidelines Committee in April 2024:

• European Respiratory Society guidelines for the diagnosis of asthma in adults [Louis et al, 2022]
• European Respiratory Society guidelines for the diagnosis of asthma in children 5–16 years [Gaillard et al, 2021]
• Global Strategy for Asthma Management and Prevention [GINA 2023] The 2024 and 2025 editions were considered to meet the same criteria.
• NAEPP 2020 focused updates to the Asthma Management Guidelines [NAEPPCC]

Selection of most relevant body of evidence and recommendations

For each topic/clinical question in the agreed scope, the medical writer extracted recommendations and evidence summaries from the candidate guidelines.

Development of recommendations

Assigning method according to topic

For each topic or clinical question identified in the scope and scheduled for immediate update, the Guidelines Committee agreed on the method for synthesising evidence and developing recommendations: existing evidence synthesis (where it was expected that a source guideline would report high-quality evidence on the topic), consensus informed by existing guidelines and available evidence, or a new literature search. This process was completed during the planning stage, before selection of source guidelines for adaptation. 

Analysing source guidance

For each topic area, Guidelines Committee members received:

• a summary of the relevant source guidelines’ recommendations and evidence
• a structured worksheet to guide them in identifying the most reliable and relevant evidence on each subtopic or clinical question, deciding whether to adopt/adapt existing recommendations from a source guideline or develop new consensus recommendation, and drafting recommendations.

Over a series of meetings between April 2024 and July 2025, the Guidelines Committee assessed evidence and recommendations in source guidelines, considered their application to Australian primary care, and drafted recommendations.

Development of recommendations for sections subject to interim update

For sections undergoing interim update (see update status by topic), recommendations from the previous edition of the Handbook were assessed for currency by the Clinical Executive Lead and Guidelines Committee, and amended as necessary.

Development of information to support the recommendations

Under the guidance and instructions of the Guidelines Committee, the medical writer drafted supporting material, including rationale statements, evidence summaries and practice points, based on collated worksheets completed by Guidelines Committee members on each topic.

The Guidelines Committee reviewed draft recommendations and supporting text.

Future updates

Ongoing updates will occur continually, topic by topic, by identifying, analysing and synthesising published evidence.

References

The AGREE Next Steps Consortium. Appraisal of Guidelines for Research and Evaluation II. 2013: https://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf

Gaillard EA, Kuehni CE, Turner S, et al. European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years. Eur Respir J 2021; 58: 2004173. https://erj.ersjournals.com/content/erj/58/5/2004173.full.pdf

GINA. Global Strategy for Asthma Management and Prevention (2023 update) Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023. Updated May 2023: GINA; 2023. Available from: www.ginasthma.org/reports

GINA. Global Strategy for Asthma Management and Prevention (2024 update) Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Updated May 2024. Available from: www.ginasthma.org/reports

GINA. Global Strategy for Asthma Management and Prevention (2025 update) Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Available from: www.ginasthma.org/reports

Louis R, Satia I, Ojanguren I, et al. European Respiratory Society Guidelines for the diagnosis of asthma in adults. Eur Respir J 2022: 2101585. https://erj.ersjournals.com/content/erj/60/3/2101585.full.pdf

NAEPP 2020 focused updates to the Asthma Management Guidelines (NAEPPCC)  Expert Panel Working Group of the National Heart Lung and Blood Institute administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 Focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. The Journal of Allergy and Clinical Immunology 2020; 146: 1217-1265. https://www.sciencedirect.com/science/article/pii/S0091674920314044

NHMRC. Table 2. Assessing a guideline’s suitability to adopt or adapt. In: Guidelines for Guidelines Handbook [web page] Accessed October 2023: https://www.nhmrc.gov.au/guidelinesforguidelines/plan/adopt-adapt-or-start-scratch

SIGN158 British guideline on the management of asthma (July 2019 edition) Scottish Intercollegiate Guidelines Network and British Thoracic Society. British guideline on the management of asthma. London; SIGN: 2019. https://www.sign.ac.uk/media/1773/sign158-updated.pdf

Contributors to the Australian Asthma Handbook

Other contributors