Anticholinergic therapy for acute asthma in children (Review)

Laurel Teoh, C Cates, Mark Hurwitz, Jason Acworth, Peter Van Asperen, Anne Chang

    Research output: Contribution to journalArticleResearchpeer-review

    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.

    Objectives: 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.
    Original languageEnglish
    Article numberCD003797
    Pages (from-to)1-47
    Number of pages47
    JournalCochrane Database of Systematic Reviews
    Volume2012
    Issue number4
    DOIs
    Publication statusPublished - 18 Apr 2012

    Fingerprint

    Cholinergic Antagonists
    Asthma
    Therapeutics
    Treatment Failure
    Bronchodilator Agents
    Odds Ratio
    Pharmaceutical Preparations
    Drug Combinations
    Sample Size
    Patient Selection
    Meta-Analysis
    Hospitalization
    Randomized Controlled Trials
    Placebos

    Cite this

    Teoh, Laurel ; Cates, C ; Hurwitz, Mark ; Acworth, Jason ; Van Asperen, Peter ; Chang, Anne. / Anticholinergic therapy for acute asthma in children (Review). In: Cochrane Database of Systematic Reviews. 2012 ; Vol. 2012, No. 4. pp. 1-47.
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    title = "Anticholinergic therapy for acute asthma in children (Review)",
    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.Objectives: 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.",
    author = "Laurel Teoh and C Cates and Mark Hurwitz and Jason Acworth and {Van Asperen}, Peter and Anne Chang",
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    Teoh, L, Cates, C, Hurwitz, M, Acworth, J, Van Asperen, P & Chang, A 2012, 'Anticholinergic therapy for acute asthma in children (Review)', Cochrane Database of Systematic Reviews, vol. 2012, no. 4, CD003797, pp. 1-47. https://doi.org/10.1002/14651858.CD003797.pub2

    Anticholinergic therapy for acute asthma in children (Review). / Teoh, Laurel; Cates, C; Hurwitz, Mark; Acworth, Jason; Van Asperen, Peter; Chang, Anne.

    In: Cochrane Database of Systematic Reviews, Vol. 2012, No. 4, CD003797, 18.04.2012, p. 1-47.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Anticholinergic therapy for acute asthma in children (Review)

    AU - Teoh, Laurel

    AU - Cates, C

    AU - Hurwitz, Mark

    AU - Acworth, Jason

    AU - Van Asperen, Peter

    AU - Chang, Anne

    PY - 2012/4/18

    Y1 - 2012/4/18

    N2 - 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.Objectives: 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.

    AB - 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.Objectives: 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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    JO - Cochrane database of systematic reviews (Online)

    JF - Cochrane database of systematic reviews (Online)

    SN - 1469-493X

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    M1 - CD003797

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