Table 4. Grading System for Recommendations
Category/Grade
Definition
Level of Evidence
Ia
Ib
IIa
IIb
Evidence from meta-analysis of randomized controlled trials
Evidence from at least one randomized controlled trial
Evidence from at least one controlled study without randomization
Evidence from at least one other type of quasi-experimental study
Evidence from non-experimental descriptive studies, such as
III
comparative studies
Evidence from expert committee reports or opinions or clinical
IV
experience of respected authorities or both
Strength of Recommendation
A
Directly based on category I evidence
Directly based on category II evidence or extrapolated recommendation
B
from category I evidence
C
D
E
Directly based on category III evidence or extrapolated
recommendation from category I or II evidence
Directly based on category IV evidence or extrapolated
recommendation from category I, II, or III evidence
Based on consensus of the Joint Task Force on Practice Parameters
Abbreviations
BHR, Bronchial hyperresponsiveness; COPD, chronic obstructive pulmonary disease;
EIA, exercise-induced asthma; EIAna, exercise-induced anaphylaxis; EIB, exercise-induced
bronchoconstriction; FEV1, forced expiratory volume in one second; EILD, exercise-induced
laryngeal dysfunction; EVH, eucapnic voluntary hyperpnea; GERD, gastroesophageal reflux
disease; HRmax, maximum heart rate; ICS, inhaled corticosteroids; LABA, Long-acting
β2-agonists; PD20 or PC20, provocation dose or provocative concentration causing a decrease of
20%; SABA, short-acting β2-agonists; VCD, vocal cord dysfunction
Source
Weiler JM, Anderson SD, Randolph C, Bonini S, Craig TJ, Pearlman DS, et al.
Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction:
a practice parameter. Ann Allergy Asthma Immunol. 2010 Dec;105(6 Suppl):S1-47.
Disclaimer
This Guideline attempts to define principles of practice that should produce high-quality patient care.
It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This
Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining
the same results. The ultimate judgment concerning the propriety of any course of conduct must be
made by the clinician after consideration of each individual patient situation.
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