Article type
Year
Abstract
Objective: The aims of this study were to estimate the magnitude of therapeutic effects attributable to the addition of inhaled anticholinergics to beta2-agonists in acute pediatric asthma.
Methods: We identified randomized controlled trials (RCTs) through (1) systematic searches of Medline (1966 to 1996), EMBASE (1980 to 1995) and CINAHL (1982 to 1995); (2) reference lists from identified RCTs; (3) correspondence with pharmaceutical companies; and (4) personal contact with trialists. RCTs comparing the combination of inhaled anticholinergics and beta2-agonists with beta2-agonists alone in children aged 18 months to 17 years with acute asthma were considered for inclusion. The primary endpoint was the hospital admission. Secondary endpoints were considered including: pulmonary function tests (PFTs), need for corticosteroids, and relapse.
Results: Of the 37 identified studies, 10 RCTs were relevant and most (N=8) were of high quality. Studies were categorized according to the number of anticholinergic inhalations added to the beta2-agonist regimen; one study tested two protocols. In single dose protocols (N=5), no reduction in hospital admission attributable to combination therapy was observed [OR=0.8 (99%CI:0.3,2.4), N=2]. In multiple dose protocols (N=5), a reduction in hospital admission rate was observed favouring combination therapy [OR=0.6 (0.3,1.1), N=5]. Eleven patients would need to be treated to avoid one admission. In the protocol titrating the number of combined anticholinergic and beta2-agonist inhalations to patients' response (N=1), no group differences were observed for the few available outcomes.
Discussion: The addition of a single inhalation of anticholinergics to the beta2-agonist regimen does not have notable effect on hospital admission. Multiple dose protocols may avoid hospital admission in 1 of 11 such treated patients. These results seem to apply to children with moderate and severe asthma exacerbations.
Methods: We identified randomized controlled trials (RCTs) through (1) systematic searches of Medline (1966 to 1996), EMBASE (1980 to 1995) and CINAHL (1982 to 1995); (2) reference lists from identified RCTs; (3) correspondence with pharmaceutical companies; and (4) personal contact with trialists. RCTs comparing the combination of inhaled anticholinergics and beta2-agonists with beta2-agonists alone in children aged 18 months to 17 years with acute asthma were considered for inclusion. The primary endpoint was the hospital admission. Secondary endpoints were considered including: pulmonary function tests (PFTs), need for corticosteroids, and relapse.
Results: Of the 37 identified studies, 10 RCTs were relevant and most (N=8) were of high quality. Studies were categorized according to the number of anticholinergic inhalations added to the beta2-agonist regimen; one study tested two protocols. In single dose protocols (N=5), no reduction in hospital admission attributable to combination therapy was observed [OR=0.8 (99%CI:0.3,2.4), N=2]. In multiple dose protocols (N=5), a reduction in hospital admission rate was observed favouring combination therapy [OR=0.6 (0.3,1.1), N=5]. Eleven patients would need to be treated to avoid one admission. In the protocol titrating the number of combined anticholinergic and beta2-agonist inhalations to patients' response (N=1), no group differences were observed for the few available outcomes.
Discussion: The addition of a single inhalation of anticholinergics to the beta2-agonist regimen does not have notable effect on hospital admission. Multiple dose protocols may avoid hospital admission in 1 of 11 such treated patients. These results seem to apply to children with moderate and severe asthma exacerbations.