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Anticholinergic therapy for acute asthma in children (Review)

Teoh, Laurel, Cates, C., Hurwitz, Mark, Acworth, Jason, van Asperen, Peter and Chang, Anne B. (2012). Anticholinergic therapy for acute asthma in children (Review). Cochrane Database of Systematic Reviews,2012(4):1-44.

Document type: Journal Article
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NHMRC Grant No. 545216
Title Anticholinergic therapy for acute asthma in children (Review)
Author Teoh, Laurel
Cates, C.
Hurwitz, Mark
Acworth, Jason
van Asperen, Peter
Chang, Anne B.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2012
Volume Number 2012
Issue Number 4
ISSN 1469-493X   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84864071651
Start Page 1
End Page 44
Total Pages 44
Place of Publication United Kingdom
Publisher John Wiley & Sons Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Inhaled anticholinergics as single agent bronchodilators (or in combination with beta2-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.

Search methods
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.

Selection criteria
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.

Data collection and analysis
Two authors independently selected trials, extracted data and assessed trial quality.

Main results
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 beta2-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 beta2-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.

Authors' conclusions
In children over the age of two years with acute asthma exacerbations, inhaled anticholinergics as single agent bronchodilators were less efficacious than beta2-agonists. Inhaled anticholinergics were also less efficacious than inhaled anticholinergics combined with beta2-agonists. Inhaled anticholinergic drugs alone are not appropriate for use as a single agent in children with acute asthma exacerbations.
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