Critical appraisal of international adult bronchiectasis guidelines using the AGREE II tool

Sofia Tejada (Lead / Corresponding author), Sergio Ramírez-Estrada, Alexandre M. Tejo, Carlos G. Forero, Xavier Pomares, Miguel Gallego, Joan B. Soriano, James D. Chalmers, Jordi Rello

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Guidelines aim to standardize and optimize diagnosis and management. We evaluated the quality of evidence supporting recommendations from different international adult guidelines on bronchiectasis, and classified with the GRADE system.

Methods: Quality of eligible clinical practice guidelines was assessed for six domains using the AGREE II tool, with ≥ 80% rating as excellent.

Results: Seven guidelines (283 recommendations) were analyzed, and four of them were considered "recommended for use" (three reported after 2017 as excellent). Overall, 144 (50.9%) recommendations were based on low-quality evidence, representing 81.5% in diagnosis and 36.2% in therapy. In contrast, 5/92 (5.4%) and 40/191 (20.9%) recommendations regarding diagnostic and treatment (respectively) were based on high-quality evidence. Quality agreement ratings were significantly (p< 0.05) higher for guidelines delivered after 2015, progressing from 27.7% to 58.3%, qualifying as excellent. Highest scores were documented in the domains of "scope and purpose" followed by "clarifying of presentation" and “editorial independence”.

Conclusion: Updated guidelines reported after 2017 improved quality, although well-designed randomized clinical trials remain an unmet need. AGREE II quality assessment identified four guidelines qualified as recommended for use. Improvements are required in stakeholder involvement and applicability.

Original languageEnglish
Pages (from-to)4-11
Number of pages8
JournalEuropean Journal of Internal Medicine
Early online date21 Jan 2022
Publication statusPublished - Apr 2022


  • Bronchiectasis
  • Clinical practice guidelines
  • Quality of evidence

ASJC Scopus subject areas

  • Internal Medicine


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