Children and adolescents experiencing acute exacerbations of
asthma benefit from the use of beta(2)-adrenoceptor agonists (beta(2)-agonists) and systemic
corticosteroids. However, there have been conflicting reports regarding the efficacy of inhaled
anticholinergic agents. This article summarizes the evidence provided by randomized controlled trials studying the efficacy of adding inhaled
anticholinergic agents to beta(2)-agonists in nonhospitalized children and adolescents with acute exacerbations of
asthma. This systematic review of randomized controlled trials suggests that the addition of inhaled
anticholinergic agents to beta(2)-agonists is beneficial in children and adolescents, particularly those with severe exacerbations of
asthma. When given in repeated doses, the addition of inhaled
anticholinergic agents to beta(2)-agonists improves lung function and reduces the risk of hospital admission by 25%. Several treatment regimens, namely
ipratropium bromide (250 or 500 microg per dose) every 20-60 minutes for two to three doses have been tested with similar beneficial effects. The addition of a single dose of an inhaled
anticholinergic agent to beta(2)-agonists improves lung function but does not prevent hospital admission. The review did not identify any beneficial effects of
anticholinergic agents in children with nonsevere
asthma. Use of
anticholinergic agents was not associated with increase in the incidence of
nausea,
vomiting or
tremor. In conclusion, the addition of repeated doses of an inhaled
anticholinergic agent to inhaled beta(2)-agonist is indicated in the emergency room management of children and adolescents with acute
asthma, particularly those with severe exacerbations.