Multiple doses of anticholinergics are beneficial in severe, acute childhood asthma

Multiple doses of anticholinergics are beneficial in severe, acute childhood asthma

The addition of anticholinergics to $beta$ ₂ agonist inhalations remains controversial in the treatment of children and adolescentswith asthma exacerbations. To examine the efficacy of three managementstrategies for adding anticholinergics to $beta$ ₂ agonists, Plotnickand Ducharme (p 971) systematically reviewed 10 randomised controlledtrials, including single dose, multiple doses (predetermined protocol),and multiple doses (flexible protocol). Only the addition of multipledoses of anticholinergics to $beta$ ₂ agonists in a predetermined protocolreduced the risk of hospital admission (by 30%) and improved pulmonaryfunction tests. Eleven children would need to be treated to avoidone admission. The use of anticholinergics in mild to moderateasthma is not supported by the available evidence. The numberand size of pooled studies remain small, thus the conclusionsare subject to change with future largertrials.

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Should inhaled anticholinergics be added to $beta$ ₂ agonists for treating acute childhood and adolescent asthma? A systematic review: Laurie H Plotnick and Francine M Ducharme
BMJ 1998 317: 971-977. [Abstract] [Full Text] [PDF]