[Show abstract][Hide abstract] ABSTRACT: Asthma is a condition that affects the airways (tubes carrying air in and out of the lungs). During an asthma exacerbation (attack), the airways narrow and drugs can be taken to dilate, or widen, the airways. Common bronchodilators (medicines used to widen the airways) are short-acting beta2- agonists (e.g. salbutamol) or anticholinergics (e.g. ipratropium bromide). In this review, we examined if the use of anticholinergic inhalers during an asthma attack in children aged over two years is effective compared to either placebo or another bronchodilator. We also looked at combinations of anticholinergic plus a beta2-agonist compared to an anticholinergic on its own. We found six small trials of unclear quality answering these two questions. We found data from four trials on 171 children comparing anticholinergics with beta2-agonists. Children on anticholinergics alone were significantly more likely to experience treatment failure than those on beta2-agonists (odds ratio (OR) 2.27; 95% CI 1.08 to 4.75). We also found data from four trials on 173 children comparing children on anticholinergics alone with children on anticholinergics plus beta2-agonists. In this case, treatment failure was more likely in children taking anticholinergics only than if they were combined with beta2-agonists (OR 2.65; 95% CI 1.2 to 5.88). We were only able to combine data for treatment failure and hospitalisation. In summary, we found that inhaled anticholinergics used on their own are less effective than inhaled beta2-agonists used alone or in combination with anticholinergics. Inhaled anticholinergics seem safe, with no significant side effects apparent.
[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.