Acute asthma in children and adolescents: should inhaled anticholinergics be added to beta(2)-agonists?

Laurie H Plotnick, Francine M Ducharme
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引用次数: 35

Abstract

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.

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儿童和青少年急性哮喘:吸入抗胆碱能药物是否应加入β(2)-激动剂?
急性哮喘发作的儿童和青少年受益于β(2)-肾上腺素能受体激动剂(β(2)-激动剂)和全身皮质类固醇的使用。然而,关于吸入抗胆碱能药物的疗效,有相互矛盾的报道。本文总结了随机对照试验提供的证据,这些试验研究了在β(2)-激动剂的基础上添加吸入抗胆碱能药物对非住院儿童和青少年哮喘急性加重的疗效。这一随机对照试验的系统综述表明,在β(2)-激动剂的基础上添加吸入抗胆碱能药物对儿童和青少年有益,特别是那些哮喘严重恶化的儿童和青少年。当重复给药时,在β(2)-激动剂的基础上加入吸入抗胆碱能药物可改善肺功能,并将住院风险降低25%。几种治疗方案,即异丙托溴铵(每剂量250或500微克)每20-60分钟服用两至三次,已经过试验,具有类似的有益效果。在β(2)-激动剂的基础上加入单剂量的吸入抗胆碱能药物可改善肺功能,但不能防止住院。该综述未发现抗胆碱能药物对非严重哮喘儿童有任何有益作用。使用抗胆碱能药物与恶心、呕吐或震颤的发生率增加无关。综上所述,在吸入β(2)-激动剂的基础上,重复剂量的吸入抗胆碱能药物适用于急性哮喘儿童和青少年的急诊室管理,特别是那些严重发作的儿童和青少年。
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