Double-blind study with Duovent and placebo in 20 asthmatic children

Anticholinergic therapy for acute asthma in children

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 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 beta(2)-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 beta(2)-agonists. Inhaled anticholinergics were also less efficacious than inhaled anticholinergics combined with beta(2)-agonists. Inhaled anticholinergic drugs alone are not appropriate for use as a single agent in children with acute asthma exacerbations.

Inhaled anti-cholinergics for prolonged non-specific cough in children

BACKGROUND

Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice. These children are treated with a variety of therapies including inhaled anti-cholinergic medications.

OBJECTIVES

To determine the efficacy of inhaled anti-cholinergic medications in the management of prolonged non-specific cough in children.

SEARCH STRATEGY

The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register and Cochrane Airways Group, MEDLINE and EMBASE databases were searched. Relevant pharmaceutical companies were contacted. The latest searches were performed in July 2003.

SELECTION CRITERIA

All randomised controlled trials comparing inhaled anti-cholinergic medication with a placebo medication.

DATA COLLECTION AND ANALYSIS

Results of searches were reviewed against pre-determined criteria for inclusion. No eligible trials were identified and thus no data were available for analysis. A single small trial in adults has been reported.

MAIN RESULTS

No randomised-controlled trials that examined the efficacy of inhaled anti-cholinergic medications in the management of prolonged non-specific cough in children were found.

REVIEWER'S CONCLUSIONS

There is currently no evidence to support the use of inhaled anti-cholinergics for symptomatic control of non-specific cough in children. Further research examining the effects of this intervention is needed.