The Role of Anticholinergics in Acute Asthma Treatment (original) (raw)
Related papers
BMJ, 1998
Objectives To estimate the therapeutic and adverse effects of addition of inhaled anticholinergics to 2 agonists in acute asthma in children and adolescents. Design Systematic review of randomised controlled trials of children and adolescents taking 2 agonists for acute asthma with or without the addition of inhaled anticholinergics. Main outcome measures Hospital admission, pulmonary function tests, number of nebulised treatments, relapse, and adverse effects. Results Of 37 identified trials, 10 were relevant and six of these were of high quality. The addition of a single dose of anticholinergic to 2 agonist did not reduce hospital admission (relative risk 0.93, 95% confidence interval 0.65 to 1.32). However, significant group differences in lung function supporting the combination treatment were observed 60 minutes (standardised mean difference − 0.57, − 0.93 to − 0.21) and 120 minutes ( − 0.53, − 0.90 to − 0.17) after the dose of anticholinergic. In contrast, the addition of multiple doses of anticholinergics to 2 agonists, mainly in children and adolescents with severe exacerbations, reduced the risk of hospital admission by 30% (relative risk 0.72, 0.53 to 0.99). Eleven (95% confidence interval 5 to 250) children would need to be treated to avoid one admission. A parallel improvement in lung function (standardised mean difference − 0.66, − 0.95 to − 0.37) was noted 60 minutes after the last combined inhalation. In the single study where anticholinergics were systematically added to every 2 agonist inhalation, irrespective of asthma severity, no group differences were observed for the few available outcomes. There was no increase in the amount of nausea, vomiting, or tremor in patients treated with anticholinergics. Conclusions Adding multiple doses of anticholinergics to 2 agonists seems safe, improves lung function, and may avoid hospital admission in 1 of 11 such treated patients. Although multiple doses should be preferred to single doses of anticholinergics, the available evidence only supports their use in school aged children and adolescents with severe asthma exacerbation.
Anticholinergic therapy for acute asthma in children
Reviews, 2012
Background Inhaled anticholinergics as single agent bronchodilators (or in combination with beta 2-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 beta 2-agonists from four trials on 171 1 Anticholinergic therapy for acute asthma in children (Review)
Current role of anticholinergic drugs in the treatment of asthma: key messages for clinical practice
Polish Archives of Internal Medicine, 2015
role of anticholinergic drugs in the treatment of asthma... 859 variable respiratory symptoms (wheeze, shortness of breath, chest tightness, and cough) and variable airflow limitation. 4 It is now commonly recognized that the main objective of asthma treatment is to achieve and maintain asthma control and to prevent future risks including worsening, exacerbations, accelerated loss of lung function, and side effects of treatment. 4 Despite remarkable recent advances in the understanding of asthma epidemiology, physiopathology, and management, current evidence suggests that asthma control is still Introduction Asthma is one of the most common chronic noncommunicable respiratory diseases worldwide. The disease imposes great personal and social burden and currently ranks No. 15 of the global top 25 causes of years lived in disability. 1 Although characteristically asthma is a disease of children and young adults, 2 it affects all age groups, and late-onset asthma in adults and elderly individuals is not uncommon. 3 Currently, asthma is defined as a heterogeneous disease, usually characterized by chronic airway inflammation and clinically expressed by a history of
Anticholinergic agents for chronic asthma in adults
2004
Background Anticholinergic agents such as ipratropium bromide are sometimes used in the treatment of chronic asthma. They e ect bronchodilation and have also been used in combination with ß2-agonists in the management of chronic asthma. Objectives To examine the e ectiveness of anticholinergic agents versus placebo and in comparison with ß2-agonists or as adjunctive therapy to ß2-agonists. Search methods The Cochrane Airways Group asthma and wheeze database was searched with a pre-defined search strategy. Searches were current as of August 2008. Reference lists of articles were also examined. Selection criteria Randomised trials or quasi-randomised trials were considered for inclusion. Studies assessing an anticholinergic agent versus placebo or in combination/comparison with ß2-agonists were included. In practice, all ß2-agonists were short acting. Short-term (less than 24 hours duration) were not considered for this review. Data collection and analysis Two reviewers independently assessed abstracts for retrieval of full text articles. Papers were then assessed for suitability for inclusion in the review. Data from included studies were extracted by two reviewers and entered into the so ware package (RevMan 4.2). We contacted authors for missing data and some responded. Adverse e ect data were analysed if reported in the included studies. Main results The studies analysed were in two groups: those comparing anticholinergics with placebo and those comparing the combination of anticholinergics with short acting ß2-agonists versus short acting ß2-agonists alone. The former group had 13 studies involving 205 participants included in this review, and the latter 9 studies involving 440 patients. Generally methodological quality was poorly reported, and there were some reservations with respect to the quality of the studies. Despite the limited number of studies that could be combined, anticholinergic agents in comparison with placebo resulted in more favourable symptom scores particularly in respect of daytime dyspnoea (WMD-0.09 (95%CI-0.14,-0.04, 3 studies, 59 patients). Daily peak flow measurements also showed a statistically significant improvement for the anticholinergic (e.g. morning PEF: WMD =14.38 litres/min (95%CI 7.69, 21.08; 3 studies, 59 patients). However the Anticholinergic agents for chronic asthma in adults (Review)
2005
2 Background: Current guidelines recommend the use of a combination of inhaled beta2-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. This review was undertaken to incorporate the more recent evidence available about the effectiveness of treatment with beta2-agonists and anticholinergics compared with beta2-agonists in acute asthma treatment. Methods: A search was conducted of all randomised controlled trials published prior to
The Journal of Emergency Medicine, 2006
Background: Current guidelines recommend the use of a combination of inhaled b 2 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 b 2 agonists and anticholinergics compared with b 2 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 = 20.54; 95% CI 20.28 to 20.81, p = 0.0001) and adults (SMD = 20.36; 95% CI 20.23 to 20.49, p = 0.00001).
Anticholinergic and sympathomimetic combination therapy of asthma
Journal of Allergy and Clinical Immunology, 1983
The role of the anticholinergic drug, ipratropium bromide, in maintenance antiasthmatic therap) kt'a.s e,~aluated in a double-blind crossover trial of three bronchodilator regimens: (I) inhaled ipratropium, placebo, and oral oxtriphylline; (2) inhaled fenoterol, placebo, and oral oxtriphylline; and (3) both inhaled ipratropium and fenoterol plus oral oxtriphylline. Twenty-two asthmatics were treated with all three regimens, each for I mo, allocated in random sequence. On the first and last treatment days of each month, spirometric measurements were performed before and 0.5, I, 2, 3, 4, and 6 hr after administration of the test drugs. On the$rst treatment day of each month, all regimens produced significant bronchodilatation at 30 min after dose, an improvement that declined between 3 and 6 hr after dose. After continuous administration for I mo the two combinations employing fenoterol showed a decline in bronchodilator responsiveness from the initial treatment day, measured as the level of response (v,,) or duration of response (FEV,, VC). lpratropium plus oxtriphylline showed no such decline, suggesting the development of tolerance to long-term administration of fenoterol. Overall benejit at the end of 1 mo. measured as the area under the curves of FEVI, VC, or r',, vs time after dose, was greatest for the triple drug regimen. There were no differences in heart rate, blood pressure response. or side effects among the three treatments. It is concluded that when the anticholinergic drug ipratropium is administered concurrently with an inhaled beta2 agonist and an oral theophylline derivative, increased bronchodilatation occurs with no detectable additional side efiects. (JAUERGY CUNIMMUNOL 71:317, 1983.) Combination bronchodilator therapy, employing a beta-adrenoreceptor agonist and a theophylline derivative, has been demonstrated to be more effective than treatment with either agent alone for both stable and acutely ill asthmatics.le3 If the combination of two sympathomimetic agents acting via different mechanisms can produce greater bronchodilatation with fewer side effects than either agent used alone, it is possible that the addition of an anticholinergic bronchodilator could further improve treatment resuits. Ipratropium bromide, an N-isopropyl derivative of atropine, is an effective aerosol bronchodilator free of the unwanted systemic side effects of the parent From the Division of Respiratory Medicine,
The Cochrane database of systematic reviews, 2014
Inhaled anticholinergics given in addition to β2-agonists are effective in reducing hospital admissions in children presenting to the emergency department with a moderate to severe asthma exacerbation. It seems logical to assume a similar beneficial effect in children hospitalised for an acute asthma exacerbation. To assess the efficacy and safety of anticholinergics added to β2-agonists as inhaled or nebulised therapy in children hospitalised for an acute asthma exacerbation. To investigate the characteristics of patients or therapy, if any, that would influence the magnitude of response attributable to the addition of anticholinergics. We identified trials from the Cochrane Airways Group Specialised Register of trials (CAGR), which is derived through systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED and PsycINFO and through handsearching of respiratory journals and meeting abstracts....
Cochrane Database of Systematic Reviews, 2017
Background Inhaled short-acting anticholinergics (SAAC) and short-acting beta-agonists (SABA) are e ective therapies for adult patients with acute asthma who present to the emergency department (ED). It is unclear, however, whether the combination of SAAC and SABA treatment is more e ective in reducing hospitalisations compared to treatment with SABA alone. Objectives To conduct an up-to-date systematic search and meta-analysis on the e ectiveness of combined inhaled therapy (SAAC + SABA agents) vs. SABA alone to reduce hospitalisations in adult patients presenting to the ED with an exacerbation of asthma. Search methods We searched MEDLINE, Embase, CINAHL, SCOPUS, LILACS, ProQuest Dissertations & Theses Global and evidence-based medicine (EBM) databases using controlled vocabulary, natural language terms, and a variety of specific and general terms for inhaled SAAC and SABA drugs. The search spanned from 1946 to July 2015. The Cochrane Airways Group provided search results from the Cochrane Airways Group Register of Trials which was most recently conducted in July 2016. An extensive search of the grey literature was completed to identify any other potentially relevant studies. Selection criteria Included studies were randomised or controlled clinical trials comparing the e ectiveness of combined inhaled therapy (SAAC and SABA) to SABA treatment alone to prevent hospitalisations in adults with acute asthma in the emergency department. Two independent review authors assessed studies for inclusion using predetermined criteria. Data collection and analysis For dichotomous outcomes, we calculated individual and pooled statistics as risk ratios (RR) or odds ratios (OR) with 95% confidence intervals (CI) using a random-e ects model and reporting heterogeneity (I). For continuous outcomes, we reported individual trial results using mean di erences (MD) and pooled results as weighted mean di erences (WMD) or standardised mean di erences (SMD) with 95% CIs using a random-e ects model. Main results We included 23 studies that involved a total of 2724 enrolled participants. Most studies were rated at unclear or high risk of bias. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma (Review)