Beta-agonists and anticholinergics decrease the hospitalization rate for adults with severe asthma

SOURCE

Kirkland SW, et al. (2017) Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma.Cochrane Database Sys Rev 11;1:CD001284.

CONTEXT

Between 7% and 22% of adults presenting to anemergency department for an acute asthma attack are hospitalized. The initial treatment most commonly used in the emergency management is nebulized beta agonists and short acting anticholinergic agents. However, it is not certain whether the addition of an anticholinergic decreases the rate of hospitalization.

CLINICAL QUESTION

Doesthe combined use of nebulized beta-agonists and anticholinergics compared to nebulized beta agonists alone reduce the rate of hospitalization of patients presenting to the emergency departmentfor an asthma attack?

BOTTOM LINE

Treatment with combined nebulization of beta-agonists and short-acting anticholinergics significantly reduced the hospitalization rate for patients with severe asthma attacks.  For patients with mild or moderate asthma attacks, the reduction in the rate of hospitalization was not statistically significant.

Combination therapy also showeda significant decrease in the rate of returnemergency department visits and a significant improvement in peak expiratory flow, but at the expense of more relatively minor adverse effects (dry mouth, tremor, anxiety) (moderate level of evidence).

CAVEAT

Due to the small sample sizes, statistical heterogeneity and moderate to high risk of bias, the included studies were graded as low to medium quality. The analysis did not determine whether the number of doses (single or multiple) had an impact on the patient’s hospitalization rate. The benefits of combined treatment appear to be independent of additional treatments (aminophylline, corticosteroid) that were administered.

AUTHOR INFORMATION

Julie DUMOUCHEL
Centre Hospitalo-Universitaire de Tours
Tours, France
dumouchel.julie76@yahoo.fr

Daniel MEYRAN
Groupement Santé – Bataillon de Marins Pompiers de Marseille
Marseille, France
daniel.meyran@me.com

Kirk MAGEE
Dalhousie University – Halifax Infirmary
Nova Scotia, Canada
kirk.magee@dal.ca