[show abstract][hide abstract] ABSTRACT: Inhaled anticholinergics as single agent bronchodilators (or in combination with beta(2)-agonists) are one of the several medications available for the treatment of acute asthma in children.
To determine the effectiveness of only inhaled anticholinergic drugs (i.e. administered alone), compared to a control in children over the age of two years with acute asthma.
The Cochrane Register of Controlled Trials (CENTRAL), and the Cochrane Airways Group Register of trials were searched by the Cochrane Airways Group. The latest search was performed in April 2011.
We included only randomised controlled trials (RCTs) in which inhaled anticholinergics were given as single therapy and compared with placebo or any other drug or drug combinations for children over the age of two years with acute asthma.
Two authors independently selected trials, extracted data and assessed trial quality.
Six studies met the inclusion criteria but were limited by small sample sizes, various treatment regimes used and outcomes assessed. The studies were overall of unclear quality. Data could only be pooled for the outcomes of treatment failure and hospitalisation. Other data could not be combined due to divergent outcome measurements. Meta-analysis revealed that children who received anticholinergics alone were significantly more likely to have treatment failure compared to those who received beta(2)-agonists from four trials on 171 children (odds ratio (OR) 2.27; 95% CI 1.08 to 4.75). Also, treatment failure on anticholinergics alone was more likely than when anticholinergics were combined with beta(2)-agonists from four trials on 173 children (OR 2.65; 95% CI 1.2 to 5.88). Data on clinical scores/symptoms that were measured on different scales were conflicting. Individual trials reported that lung function was superior in the combination group when compared with anticholinergic agents used alone. The use of anticholinergics was not found to be associated with significant side effects.
In children over the age of two years with acute asthma exacerbations, inhaled anticholinergics as single agent bronchodilators were less efficacious than beta(2)-agonists. Inhaled anticholinergics were also less efficacious than inhaled anticholinergics combined with beta(2)-agonists. Inhaled anticholinergic drugs alone are not appropriate for use as a single agent in children with acute asthma exacerbations.
[show abstract][hide abstract] ABSTRACT: Childhood obstructive sleep apnoea (OSA) is a disorder that is characterised by repeated episodes of partial or complete upper airway obstruction (UAO) during sleep that result in disruption of normal ventilation and sleep patterns. Chronic cough in children is a significant medical problem and in some situations warrants thorough investigation. There may be an association between chronic cough and OSA as suggested in adult studies.
To evaluate the efficacy of treatment of OSA leading to the resolution of cough in the management of children with chronic cough.
We searched the Cochrane Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE and EMBASE. The latest search was performed in September 2010.
All randomised controlled trials comparing an intervention for OSA to a control group (placebo or usual treatment) in children with chronic cough.
We reviewed the search results against the pre-determined criteria for inclusion. Two review authors independently selected the studies. No eligible trials were identified and thus no data were available for analysis.
We found no randomised controlled trials that examined the efficacy of treatment of OSA in the management of children with chronic cough.
There is currently no evidence that therapies directed for OSA are useful for the management of chronic cough in children. Until further evidence is available, OSA should be managed on its own merits and the presence or absence of cough should not be used as a decision trigger. Further research examining the effects of this intervention is needed.