title: Anticholinergic therapy for acute asthma in children.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Two authors independently selected trials, extracted data and assessed trial quality.
  
  
  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.
  
  
  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.
authors.affiliation: Department of Paediatrics and Child Health, The Canberra Hospital, Canberra, Australia. laurel.teoh@act.gov.au
authors.forename: Laurel
authors.initials: L
authors.lastname: Teoh
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cates
authors.forename: Mark
authors.initials: M
authors.lastname: Hurwitz
authors.forename: Jason P
authors.initials: JP
authors.lastname: Acworth
authors.forename: Peter
authors.initials: P
authors.lastname: van Asperen
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage; D001249:Asthma / Q000188:drug therapy*; D001285:Atropine / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D005280:Fenoterol / Q000008:administration & dosage; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage; D009921:Metaproterenol / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D012602:Scopolamine Derivatives / Q000008:administration & dosage; D017211:Treatment Failure
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D012602:Scopolamine Derivatives; D005280:Fenoterol; D009921:Metaproterenol; D001285:Atropine; C017590:oxitropium; D009241:Ipratropium; D000420:Albuterol