section name header

Evidence summaries

Anticholinergic Drugs for Wheeze in Children Under the Age of Two Years

Anticholinergic therapy for wheezing children under the age of two years may not have a major impact on the severity of symptoms or clinical course of the acute illness although parents using it at home seem to identify benefits. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 6 studies with a total of 321 infants in 3 different settings (emergency room, 2 studies; hospitalised patients, 3 studies; outpatients, 1 study). The use of ipratropium bromide in the emergency department in addition to beta2-agonist resulted in significantly fewer patients requiring further therapy 45 minutes after initial therapy compared with beta2-agonist alone in one study (OR 0.22, 95% CI 0.08 to 0.61). However, in the other emergency department study, there was no difference in the frequency of a perceived 'excellent' response, change in respiratory rate or improvement in oxygen saturation.

There was no significant difference in length of hospital stay between ipratropium bromide and placebo (WMD -0.40 days, 95% CI -1.41 to 0.61; 1 study, n=31); or between ipratropium bromide and beta2-agonist combined compared with beta2-agonist alone (WMD 0.29 days, 95% CI -0.38 to 0.95; 2 studies, n=62). Combined ipratropium bromide and beta2-agonist compared to placebo showed significantly improved clinical scores at 24 hours (OR 0.06; 95% CI 0.01 to 0.23; 1 study, n=30).

In 1 study (n=46), maintenance treatment with ipratropium bromide was perceived by parents to be preferable to nebulised water overall (OR 0.15, 95% CI 0.04 to 0.64) and better than placebo for immediate response to treatment (OR 0.11; 95% CI 0.02, 0.58) although there was no significant difference in the relief of symptoms as defined by diary cards (OR 0.60; 95% CI 0.19 to 1.88).

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies), and by imprecise results (few patients and wide confidence intervals).

    References

    • Everard ML, Bara A, Kurian M, Elliott TM, Ducharme F, Mayowe V. Anticholinergic drugs for wheeze in children under the age of two years. Cochrane Database Syst Rev 2005 Jul 20;(3):CD001279 [Last assessed as up-to-date: 4 June 2008]. [PubMed]

Primary/Secondary Keywords