Review: anticholinergics in addition to {beta}2 agonists improve outcome in children and adults with acute asthma

doi:10.1136/ebm.11.1.21

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Evidence-Based Medicine 2006;11:21; doi:10.1136/ebm.11.1.21
Copyright © 2006 by the BMJ Publishing Group Ltd.

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Therapeutics

Review: anticholinergics in addition to ß₂ agonists improve outcome in children and adults with acute asthma

Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax 2005;60:740–6.[Abstract/Free Full Text]

Q In children and adults with acute asthma exacerbations, do inhaled anticholinergic agents plus ß₂ agonists improve outcome more than ß₂ agonists alone?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Internal medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Emergency medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Allergy & immunology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Respirology $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Paediatrics $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: asthma • cholinergic antagonists • adrenergic beta-agonists.

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline, EMBASE/Excerpta Medica, CINAHL, and the Cochrane ControlledTrials Register (to April 2005); hand searches of the referencelists of relevant articles and the top 20 respiratory journals;and the pharmaceutical company.

Study selection and assessment: randomised controlled trials (RCTs), published as full articlesin any language, that compared single or repeated doses of inhaledanticholinergic agents plus inhaled ß₂ agonists withinhaled ß₂ agonists alone for treatment of children(1.5–17 y of age) or adults ( $>=$ 18 y of age) with acute exacerbationsof asthma presenting at the emergency department. RCTs involvingatropine were excluded. 2 reviewers independently assessed theRCTs for inclusion and methodological quality (using the 5 pointJadad scale).

Outcomes: hospital admissions and change from baseline in spirometrictest results at 1–2 hours after the last treatment.

MAIN RESULTS
32 RCTs (1564 children; 2047 adults) met the selection criteria.The anticholinergic agent used was ipratropium bromide . . . [Full text of this article]

Frank Thien, MD, FRACP