Anticholinergics in the treatment of children and adults with acute asthma: A systematic review with Meta-Analysis

University of Santiago, Chile, CiudadSantiago, Santiago Metropolitan, Chile
Thorax (Impact Factor: 8.29). 10/2005; 60(9):740-6. DOI: 10.1136/thx.2005.040444
Source: PubMed


Current guidelines recommend the use of a combination of inhaled beta(2) agonists and anticholinergics, particularly for patients with acute severe or life threatening asthma in the emergency setting. However, this statement is based on a relatively small number of randomised controlled trials and related systematic reviews. A review was undertaken to incorporate the more recent evidence available about the effectiveness of treatment with a combination of beta(2) agonists and anticholinergics compared with beta(2) agonists alone in the treatment of acute asthma.
A search was conducted of all randomised controlled trials published before April 2005.
Data from 32 randomised controlled trials (n = 3611 subjects) showed significant reductions in hospital admissions in both children (RR = 0.73; 95% CI 0.63 to 0.85, p = 0.0001) and adults (RR = 0.68; 95% CI 0.53 to 0.86, p = 0.002) treated with inhaled anticholinergic agents. Combined treatment also produced a significant increase in spirometric parameters 60-120 minutes after the last treatment in both children (SMD = -0.54; 95% CI -0.28 to -0.81, p = 0.0001) and adults (SMD = -0.36; 95% CI -0.23 to -0.49, p = 0.00001).
This review strongly suggests that the addition of multiple doses of inhaled ipratropium bromide to beta(2) agonists is indicated as the standard treatment in children, adolescents, and adults with moderate to severe exacerbations of asthma in the emergency setting.

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Available from: Jose A Castro-Rodriguez
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    • "The treatment algorithm is a step-up and step-down approach, but is not graded by level of impairment or risk as is suggested in the EP3 guidelines. For acute attacks, Ipratropium bromide combined with β2 agonists may result in favourable outcomes in children.22 Inhaled corticosteroids are recommended as a first line treatment for persistent asthma with leukotriene receptor antagonists as an alternative.23 "
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    • "Especially when symptoms are refractory to initial treatment with β2-agonist anticholinergics should be considered [31]. The recommended dose of nebulised ipratropium bromide is (0.125-) 0.25 mg in 2-5 ml NaCl 9 mg/ml or the drug may be mixed with the β2-agonist/NaCl solution [27,31,44]. The dose may be repeated every 20 minute for the first hour and every four hour thereafter [31]. "
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