Multiple doses of anticholinergics are beneficial in severe, acute childhood asthma

The addition of anticholinergics to β₂ agonist inhalations remains controversial in the treatment of children and adolescents with asthma exacerbations. To examine the efficacy of three management strategies for adding anticholinergics to β₂ agonists, Plotnick and Ducharme (p 971) systematically reviewed 10 randomised controlled trials, including single dose, multiple doses (predetermined protocol), and multiple doses (flexible protocol). Only the addition of multiple doses of anticholinergics to β₂ agonists in a predetermined protocol reduced the risk of hospital admission (by 30%) and improved pulmonary function tests. Eleven children would need to be treated to avoid one admission. The use of anticholinergics in mild to moderate asthma is not supported by the available evidence. The number and size of pooled studies remain small, thus the conclusions are subject to change with future larger trials.