Abstract:
BACKGROUND:In the intrinsic system of controlling airway calibre, the cholinergic (muscarinic) sympathetic nervous system has an important role. Anticholinergic, anti muscarinic bronchodilators such as ipratropium bromide are frequently used in the management of childhood airway disease. In asthma, ipratropium is a less potent bronchodilator than beta-2 adrenergic agents but it is known to be a useful adjunct to other therapies, particularly in status asthmaticus. What remains unclear is the role of anticholinergic drugs in the maintenance treatment of chronic asthma. OBJECTIVES:To determine the effectiveness of anticholinergic drugs in chronic asthma in children over the age of 2 years. SEARCH STRATEGY:The Cochrane Airways Group trials register and reference lists of articles were searched in January 2002. SELECTION CRITERIA:Randomised controlled trials in which anticholinergic drugs were given for chronic asthma in children over 2 years of age were included. Studies including comparison of: anticholinergics with placebo, and anticholinergics with any other drug were included. DATA COLLECTION AND ANALYSIS:Eligibility for inclusion and quality of trials were assessed independently by two reviewers. MAIN RESULTS:Eight studies met the inclusion criteria.Three papers compared the effects of anticholinergic drugs with placebo, and a meta-analysis of these results demonstrated no statistically significant benefit of the use of anticholinergic drugs over placebo in any of the outcome measures used. The results of one of these trials could not be included in the meta-analysis but the authors did report significantly lower symptom scores with inhaled anticholinergics compared with placebo. However, there was no significant difference between ipratropium bromide and placebo in the percentage of symptom-free nights or days. Two trials studied the effects of anticholinergics on bronchial hyper responsiveness to histamine, by measuring the provocation dose of histamine needed to cause a fall of 20 % in FEV1 (PD 20). One study (comparing anticholinergics with placebo) reported a statistically significant increase in PD 20 but this was not found in another study (comparing anticholinergics with a beta-2 agonist). Both trials also examined the effect of anticholinergic drugs on diurnal variation in peak expiratory flow rate (PEFR) and reported no significant effect. Two studies compared the addition of an anticholinergic drug to a beta-2 agonist with the beta-2 agonist alone. Both trials failed to show any significant benefit from the long term use of combined anticholinergics with beta-2 agonists compared with beta-2 agonists alone. One trial compared the effects of oral and inhaled anticholinergic drugs with placebo. No statistically significant differences were found in any of the outcome measures except for a higher FEV1 / VC ratio and RV / TLC ratio with oral anticholinergic therapy when compared with placebo. REVIEWER'S CONCLUSIONS:The present review summarises the best evidence available to date. Although there were some small beneficial findings in favour of anticholinergic therapy, there is insufficient data to support the use of anticholinergic drugs in the maintenance treatment of chronic asthma in children.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
McDonald NJ,Bara AIdoi
10.1002/14651858.CD003535keywords:
subject
Has Abstractpub_date
2003-01-01 00:00:00pages
CD003535issue
3issn
1469-493Xpub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Bronchodilators are a central component for treating exacerbations of chronic obstructive pulmonary disease (COPD) all over the world. Clinicians often use nebulisers as a mode of delivery, especially in the acute setting, and many patients seem to benefit from them. However, evidence supporting this choice ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD011826.pub2
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abstract:BACKGROUND:An advance directive is a document specifying a person's preferences for treatment, should he or she lose capacity to make such decisions in the future. They have been used in end-of-life settings to direct care but should be well suited to the mental health setting. OBJECTIVES:To examine the effects of adv...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD005963.pub2
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abstract:BACKGROUND:Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). OBJECTIVES:To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations. SEARCH STRATEGY:We searched MEDLINE, EMBASE, the Cochrane Central Register o...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD001321.pub4
更新日期:2008-01-23 00:00:00
abstract:BACKGROUND:Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. OBJECTIVES:To evaluate the effectiveness and morbidity asso...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD007697.pub2
更新日期:2011-04-13 00:00:00
abstract:BACKGROUND:A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health ou...
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doi:10.1002/14651858.CD001005
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doi:10.1002/14651858.CD009903.pub3
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD003731.pub3
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abstract:BACKGROUND:Approximately 800 million women and children have anaemia, a condition thought to cause almost 9% of the global burden of years lived with disability. Around half this burden could be amenable to interventions that involve the provision of iron. Maize (corn) is one of the world's most important cereal grains...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD010187.pub2
更新日期:2018-12-22 00:00:00
abstract:BACKGROUND:Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patient...
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更新日期:2008-07-16 00:00:00
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doi:10.1002/14651858.CD007513.pub2
更新日期:2010-07-07 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008445.pub3
更新日期:2016-03-22 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD007594.pub2
更新日期:2010-01-20 00:00:00
abstract:BACKGROUND:Cervical dystonia is the most common form of focal dystonia. It is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. Most cases are idiopathic, and generally it is a life-long disorder. In recent years, botulinum toxin...
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD004314.pub2
更新日期:2005-01-25 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD007572.pub3
更新日期:2016-11-25 00:00:00
abstract:BACKGROUND:Circulating progesterone may be the cause of slower gastrointestinal movement in mid and late pregnancy. OBJECTIVES:The objective of this review was to assess the effects of different methods for treating constipation in pregnancy. SEARCH STRATEGY:We searched the Cochrane Pregnancy and Childbirth Group tri...
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001142
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Phenylketonuria results from a deficiency of the enzyme phenylalanine hydroxylase. Dietary restriction of phenylalanine keeps blood phenylalanine concentration low. Most natural foods are excluded from diet and supplements are used to supply other nutrients. Recent publications report a decrease in blood phe...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008005.pub4
更新日期:2015-03-27 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD007245.pub2
更新日期:2009-10-07 00:00:00
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doi:10.1002/14651858.CD004080.pub3
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002818.pub2
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章
doi:10.1002/14651858.CD012806.pub2
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pub_type: 杂志文章
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更新日期:2020-08-18 00:00:00
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更新日期:2006-07-19 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2010-01-20 00:00:00
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pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008040.pub2
更新日期:2010-11-10 00:00:00
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更新日期:2015-10-19 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2012-08-15 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2000-01-01 00:00:00