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

Gustavo J Rodrigo ^1* and José A Castro-Rodriguez ²

¹ Hospital Central de las FF.AA., Montevideo, Uruguay
² Universidad de Santiago de Chile, Santiago, Chile

^* To whom correspondence should be addressed. E-mail: gurodrig{at}adinet.com.uy.

Accepted 20 April 2005

Abstract

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 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) that received inhaled anticholinergics. Combined treatment also produced a significant increase on spirometric tests at 60-120 min after the last treatment in 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 beta2-agonists seems indicated as the standard treatment in children, adolescent and adult patients with moderate to severe exacerbations of asthma in the emergency setting.

Keywords: acute asthma treatment, anticholinergics, glycopyrrolate, ipratropium bromide, oxitropium bromide

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