Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma

Abstract

Background Inhaled short-acting anticholinergics (SAAC) and short-acting beta-agonists (SABA) are e ective therapies for adult patients with acute asthma who present to the emergency department (ED). It is unclear, however, whether the combination of SAAC and SABA treatment is more e ective in reducing hospitalisations compared to treatment with SABA alone. Objectives To conduct an up-to-date systematic search and meta-analysis on the e ectiveness of combined inhaled therapy (SAAC + SABA agents) vs. SABA alone to reduce hospitalisations in adult patients presenting to the ED with an exacerbation of asthma. Search methods We searched MEDLINE, Embase, CINAHL, SCOPUS, LILACS, ProQuest Dissertations & Theses Global and evidence-based medicine (EBM) databases using controlled vocabulary, natural language terms, and a variety of specific and general terms for inhaled SAAC and SABA drugs. The search spanned from 1946 to July 2015. The Cochrane Airways Group provided search results from the Cochrane Airways Group Register of Trials which was most recently conducted in July 2016. An extensive search of the grey literature was completed to identify any other potentially relevant studies. Selection criteria Included studies were randomised or controlled clinical trials comparing the e ectiveness of combined inhaled therapy (SAAC and SABA) to SABA treatment alone to prevent hospitalisations in adults with acute asthma in the emergency department. Two independent review authors assessed studies for inclusion using predetermined criteria. Data collection and analysis For dichotomous outcomes, we calculated individual and pooled statistics as risk ratios (RR) or odds ratios (OR) with 95% confidence intervals (CI) using a random-e ects model and reporting heterogeneity (I). For continuous outcomes, we reported individual trial results using mean di erences (MD) and pooled results as weighted mean di erences (WMD) or standardised mean di erences (SMD) with 95% CIs using a random-e ects model. Main results We included 23 studies that involved a total of 2724 enrolled participants. Most studies were rated at unclear or high risk of bias. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma (Review)

The BRONCH‐AHF study: effects on short‐term outcome of nebulized bronchodilators in emergency department patients diagnosed with acute heart failure

“…However, our data did not provide significant improvement in short‐term outcomes, and thus, this still remains a hypothesis to be proved. On the other hand, DN is widely extended and a very recent Cochrane review of asthmatics demonstrated DN reduces hospitalization compared to patients treated with B2A alone . Conversely, this beneficial effect was not observed in our AHF patients, as the DN group had longer LOS.…”

Conduct and reporting of citation searching in Cochrane systematic reviews: A cross‐sectional study

“…Of the 18 Cochrane reviews that reported using a citation index to conduct citation searching, 15 (83%) reported the name of the citation index(es) used. Google Scholar was reported in one review 55 ; Scopus was reported in two reviews 24,29 ; and Web of Science was reported in 13 reviews, [26][27][28][29]31,32,[34][35][36][37][38][39][40] including seven reviews [26][27][28][29]32,34,39 that reported searching the Science Citation Index (a subset of the Web of Science) in particular and one review 35 that reported searching the Core Collection (which includes the Social Sciences Citation Index and Arts & Humanities Citation Index) in particular.…”

Peculiarities of Bronchial Asthma Clinical Course in Smokers With Small Airway Diseases

“…For adults and children with moderate-severe exacerbations, treatment in the emergency department with both SABA and ipratropium, a short-acting anticholinergic, was associated with fewer hospitalizations and greater improvement in PEF and FEV 1 compared with SABA alone. [421][422][423] For children hospitalized for acute asthma, no benefits were seen from adding ipratropium to SABA, including no reduction in length of stay. 424…”