BACKGROUND: The quality and potential impact of available clinical guidelines for asthma management has not been systematically evaluated. We therefore evaluated the quality of clinical practice guidelines (CPGs) for asthma. METHODS: We performed a systematic search of scientific literature published between 2000 and 2010 to identify and select CPGs related to asthma management. We searched guideline databases, guideline developers' websites and Medline. Four independent reviewers assessed the eligible guidelines using the AGREE II instrument. We calculated the overall agreement among reviewers with the Intraclass Correlation Coefficient (ICC). RESULTS: Eighteen CPGs published between the years 2000 to 2010 were selected from a total of 1,005 references. The overall agreement among reviewers was moderate (ICC 0.78; 95%CI 0.62 to 0.90). The mean scores for each AGREE domain were: scope and purpose 44.1% (range 10.0 to 79.0%); stakeholder involvement 33.8% (range 4.0 to 66.0%); rigor of development 32.4% (range 8.0 to 64.0%); clarity and presentation 52.1% (range 17.0 to 85.0%); applicability 21.1% (range 3 to 55%); and editorial independence 25% (range 0 to 58%). None of the appraised guidelines had a score higher than 60% (recommended). Half of the appraised guidelines were recommended with modifications (9/18) or not recommended (9/18) for using in clinical practice. We observed improvement over time in guidelines' overall quality (p = 0.01; guidelines from 2001 to 2006 versus 2007 to 2009). CONCLUSIONS: The quality of guidelines for asthma care is low although it has improved over time. Greater efforts are needed to provide high quality guidelines that can be used as a reliable tool for clinical decision-making in this field.

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