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This Article Full Text Full Text (PDF) Correction (v63,p1029) All Versions of this Article: thx.2005.047803v1 60/9/740    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rodrigo, G J Articles by Castro-Rodriguez, J A Search for Related Content PubMed Articles by Rodrigo, G J Articles by Castro-Rodriguez, J A

Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis

¹ Departamento de Emergencia, Hospital Central de las FF.AA, Av 8 de Octubre 3050, Montevideo 11600 and Clinica Respirar, Benito Nardone 2310, Montevideo 11300, Uruguay
² Pediatric Pulmonary Section, Department of Pediatrics, School of Medicine, University of Chile, Santiago, Chile

Correspondence to:
Correspondence to:
Dr G J Rodrigo
Departamento de Emergencia, Hospital Central de las FF.AA, Av 8 de octubre 3020, Montevideo 11600, Uruguay; gurodrig{at}adinet.com.uy

Background: Current guidelines recommend the use of a combination of inhaled β₂ 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 β₂ agonists and anticholinergics compared with β₂ agonists alone in the treatment of acute asthma.

Methods: A search was conducted of all randomised controlled trials published before April 2005.

Results: 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).

Conclusions: This review strongly suggests that the addition of multiple doses of inhaled ipratropium bromide to β₂ agonists is indicated as the standard treatment in children, adolescents, and adults with moderate to severe exacerbations of asthma in the emergency setting.

Abbreviations: CCS, corticosteroids; ED, emergency department; FEV₁, forced expiratory volume in 1 second; NNT, number of patients needed to treat; PEF, peak expiratory flow; RR, relative risk; SMD, standardised mean difference; WMD, weighted mean difference

Keywords: anticholinergics; β2 agonists; ipratropium bromide; oxitropium bromide; glycopyrrolate; acute asthma; children