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Evidence summaries

Ipratropium as an Adjunct to Beta2 Agonists for Acute Asthma

Combination inhaled therapy with short-acting anticholinergics and short-acting beta-agonists are effective for acute asthma in adults compared with beta-agonist alone. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 23 studies with a total of 2 724 adult participants. Patients receiving combination inhaled therapy with short-acting anticholinergics (SAAC) and short-acting beta-agonists (SABA) were less likely to be hospitalised, were more likely to experience improved forced expiratory volume (FEV1) and peak expiratory flow (PEF), and were less likely to return to the emergency department for additional care than participants receiving SABA alone (table T1). In particular, combination inhaled therapy was more effective in preventing hospitalisation in adults with severe asthma exacerbations who are at increased risk of hospitalisation, compared to those with mild-moderate exacerbations. Adverse events, such as tremor, agitation, and palpitations, were more common with combination therapy compared to SABA alone (table T1).

Combination inhaled therapy compared with SABA alone for acute asthma

OutcomeRelative effect(95% CI)Assumed risk with control - SABA aloneRisk difference with intervention - SABA + SAAC (95% CI)No of Participants(studies) Quality of evidence
HospitalisationRR 0.72 (0.59 to 0.86)231 per 100065 fewer per 1000(from 30 fewer to 95 fewer)2120 (16) Moderate
Total adverse eventsOR 2.03 (1.28 to 3.20)131 per 1000103 more per 1000(from 31 more to 195 more)1392(11) Moderate
FEV1_Range 1.36 to 2.4 LitresMD 0.25 higher(0.02 to 0.48 higher)687(6) Low
Peak expiratory flow (PEF)_Range 190 to 313 litres/minMD 36.58 higher(23.07 to 50.09 higher)1056(12) Moderate
Relapse ratesRR 0.8 (0.66 to 0.98)250 per 100050 fewer per 1000(from 5 fewer to 85 fewer)1180(5) Moderate

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding in most of the studies).

References

Primary/Secondary Keywords