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Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children

  1. Benedict Griffiths1,*,
  2. Francine M Ducharme2,3

Editorial Group: Cochrane Airways Group

Published Online: 21 AUG 2013

Assessed as up-to-date: 18 APR 2012

DOI: 10.1002/14651858.CD000060.pub2


How to Cite

Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD000060. DOI: 10.1002/14651858.CD000060.pub2.

Author Information

  1. 1

    St Thomas' Hospital, Evelina Children's Hospital, London, UK

  2. 2

    University of Montreal, Department of Paediatrics, Montreal, Québec, Canada

  3. 3

    CHU Sainte-Justine, Research Centre, Montreal, Canada

*Benedict Griffiths, Evelina Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. bgriffiths@doctors.org.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 21 AUG 2013

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[Figure 1]
Figure 1. Methodological quality summary: review authors' judgments about each methodological quality item for each included study.
[Figure 2]
Figure 2. Forest plot of comparison: 1 Anticholinergic and short-acting beta2-agonists versus short-acting beta2-agonists alone (all protocols), outcome: 1.1 Primary outcome: hospital admissions.
[Figure 3]
Figure 3. In the children on short-acting beta2-agonists only, 23 people out of 100 were admitted to hospital, compared with 17 (95% CI 15 to 20) out of 100 for children on short-acting beta2-agonists plus anticholinergics.
[Figure 4]
Figure 4. Funnel plot of analysis 1.1.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 1 Primary outcome: hospital admissions.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 2 Primary outcome: hospital admissions subgrouped by trial protocol.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 3 Primary outcome: hospital admissions subgrouped by review authors' judgment of trial report.
[Analysis 1.4]
Analysis 1.4. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 4 Primary outcome: hospital admissions subgrouped by control group event rate (tertiles).
[Analysis 1.5]
Analysis 1.5. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 5 Primary outcome: hospital admissions subgrouped by co-intervention of corticosteroid.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 6 Change from baseline in % predicted FEV1, 60 minutes after the last of IB.
[Analysis 1.7]
Analysis 1.7. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 7 Change from baseline in % predicted FEV1, 120 minutes after last IB.
[Analysis 1.8]
Analysis 1.8. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 8 % Change in FEV1 or PEFR at 60 minutes after last IB (± 15 minutes).
[Analysis 1.9]
Analysis 1.9. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 9 % Change in FEV1 or PEFR at 120 minutes after last IB (± 30 minutes).
[Analysis 1.10]
Analysis 1.10. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 10 % Change in respiratory resistance at 60 minutes after IB (± 15 minutes).
[Analysis 1.11]
Analysis 1.11. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 11 % Change in respiratory resistance at 120 minutes after IB (± 30 minutes).
[Analysis 1.12]
Analysis 1.12. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 12 Change in clinical score at 120 minutes (± 30 minutes).
[Analysis 1.13]
Analysis 1.13. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 13 Need for repeat bronchodilator treatment after standard protocol prior to disposition.
[Analysis 1.14]
Analysis 1.14. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 14 O2 saturation < 95% at 60 minutes (± 15 minutes).
[Analysis 1.15]
Analysis 1.15. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 15 O2 saturation < 95% at 120 minutes (± 30 minutes).
[Analysis 1.16]
Analysis 1.16. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 16 Need for corticosteroids in emergency department prior to disposition.
[Analysis 1.17]
Analysis 1.17. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 17 Tremor.
[Analysis 1.18]
Analysis 1.18. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 18 Vomiting.
[Analysis 1.19]
Analysis 1.19. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 19 Nausea.
[Analysis 1.20]
Analysis 1.20. Comparison 1 Anticholinergic and beta2-agonists versus beta2-agonists alone (all protocols), Outcome 20 Relapse.