Combined inhaled anticholinergics and short-acting beta
      <sub>2</sub>-agonists for initial treatment of acute asthma in children

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Abstract

There are several treatment options for managing acute asthma exacerbations (sustained worsening of symptoms that do not subside with regular treatment and require a change in management). Guidelines advocate the use of inhaled short acting beta2-agonists (SABAs) in children experiencing an asthma exacerbation. Anticholinergic agents, such as ipratropium bromide and atropine sulfate, have a slower onset of action and weaker bronchodilating effect, but may specifically relieve cholinergic bronchomotor tone and decrease mucosal edema and secretions. Therefore, the combination of inhaled anticholinergics with SABAs may yield enhanced and prolonged bronchodilation.

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Traditional and largely qualitative reviews of evidence are now giving way to much more structured systematic overviews that use a quantitative method to calculate the overall effect of treatment. The latter approach is dependent on the quality of primary studies, which may introduce bias if they are of poor methodologic quality. To test the hypothesis that the inclusion of poor-quality trials in meta-analyses would bias the conclusions and produce incorrect estimates of treatment effect. An overview of randomized trials of antiestrogen therapy in subfertile men with oligospermia was performed to test the hypothesis. Data sources included online searching of MEDLINE and Science Citation Index databases between 1966 and 1994, scanning the bibliography of known primary studies and review articles, and contacting experts in the field. After independent, blind assessment, nine of 149 originally identified studies met the inclusion criteria and were selected. We assessed study quality independently. Outcome data from each study were pooled and statistically summarized. There was a marginal improvement in pregnancy rate with antiestrogen treatment (odds ratio, 1.6; 95% confidence interval, 0.9 to 2.6). Sensitivity analyses on the basis of methodologic quality demonstrated that poor-quality studies produced a positive effect with treatment, whereas no benefit was observed with high-quality studies. The results of a meta-analysis are influenced by the quality of the primary studies included. Methodologically, poor studies tend to exaggerate the overall estimate of treatment effect and may lead to incorrect inferences.

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Author and article information

Journal

Title: Cochrane Database of Systematic Reviews

Publisher: Wiley

ISSN (Electronic): 14651858

Publication date (Electronic): August 21 2013

Affiliations

[1 ]St Thomas' Hospital; Evelina Children's Hospital; Westminster Bridge Road London UK SE1 7EH

[2 ]University of Montreal; Department of Paediatrics; Montreal Québec Canada

[3 ]CHU Sainte-Justine; Research Centre; Montreal Canada

Article

DOI: 10.1002/14651858.CD000060.pub2

PubMed ID: 23966133

SO-VID: 4a6591f9-fd6d-45c7-91c9-38352e996abd

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