Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2005 Jul 20;2005(3):CD001279.
doi: 10.1002/14651858.CD001279.pub2.

Anticholinergic drugs for wheeze in children under the age of two years

M L Everard, A Bara, M Kurian, T M Elliott, F Ducharme, V Mayowe
Meta-Analysis

Anticholinergic drugs for wheeze in children under the age of two years

M L Everard et al. Cochrane Database Syst Rev. .

Abstract

Background: Wheeze in infancy and early childhood is common and appears to be increasing though the magnitude of any increase is unclear. Most wheezing episodes in infancy are precipitated by respiratory viral infections. Treatment of very young children with wheeze remains controversial. Anti-cholinergics are often prescribed but practice varies widely and the efficacy of this form of therapy remains the subject for debate.

Objectives: Wheeze in infancy and early childhood is common and appears to be increasing. Most wheezing episodes in infancy are a result of viral infection. Bronchodilator medications such as beta2-agonists and anti-cholinergic agents are often used to relieve symptoms, but patterns of use vary. The objective of this review was to assess the effects of anti-cholinergic therapy in the treatment of wheezing infants. This is a second update of this review.

Search strategy: We searched the Cochrane Airways Group Specialised Register of trials and the reference lists of articles. We contacted researchers in the field and industry sources. Searches were current as of June 2004.

Selection criteria: Randomised trials that compared anti-cholinergic therapy with placebo or beta2-agonists in wheezing children under two years of age. Children with acute bronchiolitis and chronic lung disease were excluded.

Data collection and analysis: Eligibility for inclusion and quality of trials were assessed independently by two reviewers.

Main results: Six trials involving 321 infants in three different settings were included. Compared with beta2-agonist alone, the combination of ipratropium bromide and beta2-agonist was associated with a reduced need for additional treatment, but no difference was seen in treatment response, respiratory rate or oxygen saturation improvement in the emergency department. There was no significant difference in length of hospital stay between ipratropium bromide and placebo; or between ipratropium bromide and beta2-agonist combined compared with beta2-agonist alone. However, combined ipratropium bromide and beta2-agonist compared to placebo showed significantly improved clinical scores at 24 hours. Parents preferred ipratropium bromide over nebulised water or placebo for relief of their children's symptoms at home. A further updated search conducted in June 2004 did not yield any new studies.

Authors' conclusions: There is not enough evidence to support the uncritical use of anti-cholinergic therapy for wheezing infants, although parents using it at home were able to identify benefits.

PubMed Disclaimer

Conflict of interest statement

Francine Ducharme has received some travel support from Boehringer Ingelheim to attend national and international conferences. No other potential conflicts of interest known.

Figures

1.1
1.1. Analysis
Comparison 1 HOME SETTING: Ipratropium bromide vs placebo, Outcome 1 Improvement in symptoms.
1.2
1.2. Analysis
Comparison 1 HOME SETTING: Ipratropium bromide vs placebo, Outcome 2 Parental assessment ‐ overall.
1.3
1.3. Analysis
Comparison 1 HOME SETTING: Ipratropium bromide vs placebo, Outcome 3 Parental assessment ‐ immediate.
2.1
2.1. Analysis
Comparison 2 EMERGENCY DEPT: Ipratropium bromide + beta agonist vs beta agonist, Outcome 1 Requirement for further inhaled therapy at 45 mins.
2.2
2.2. Analysis
Comparison 2 EMERGENCY DEPT: Ipratropium bromide + beta agonist vs beta agonist, Outcome 2 Respiratory rate.
2.3
2.3. Analysis
Comparison 2 EMERGENCY DEPT: Ipratropium bromide + beta agonist vs beta agonist, Outcome 3 Oxygen saturation.
2.4
2.4. Analysis
Comparison 2 EMERGENCY DEPT: Ipratropium bromide + beta agonist vs beta agonist, Outcome 4 'Excellent' responders.
3.1
3.1. Analysis
Comparison 3 HOSPITALISED: Ipratropium bromide vs placebo, Outcome 1 Days to discharge.
3.2
3.2. Analysis
Comparison 3 HOSPITALISED: Ipratropium bromide vs placebo, Outcome 2 Change in oxygen saturation at discharge or day 3.
3.3
3.3. Analysis
Comparison 3 HOSPITALISED: Ipratropium bromide vs placebo, Outcome 3 Change in symptom scores at discharge or day 3.
4.1
4.1. Analysis
Comparison 4 HOSPITALISED: Ipratropium bromide + beta agonist vs placebo, Outcome 1 Failure to decrease clinical score at 24 hours.
4.2
4.2. Analysis
Comparison 4 HOSPITALISED: Ipratropium bromide + beta agonist vs placebo, Outcome 2 Days to discharge.
5.1
5.1. Analysis
Comparison 5 HOSPITALISED: Ipratropium bromide + beta agonist vs beta agonist, Outcome 1 Days to discharge.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Henry 1984 {published data only}
    1. Henry RL, Hiller EJ, Milner AD, Hodges IG, Stokes GM. Nebulised ipratropium bromide and sodium cromoglycate in the first two years of life. Archives of Disease in Childhood 1984;59(1):54‐7. - PMC - PubMed
Mallol 1987 {published data only}
    1. Mallol J, Barrueto L, Girardi G, Toro O. Bronchodilator effect of fenoterol and ipratropium bromide in infants with acute wheezing: use of MDI with a spacer device. Pediatric Pulmonology 1987;3(5):352‐6. - PubMed
Mallol 1987b {published data only}
    1. Mallol J, Barrueto L, Girardi G, Munoz R, Puppo H, Ulloa V, et al. Use of nebulized bronchodilators in infants under 1 year of age: analysis of four forms of therapy. Pediatric Pulmonology 1987;3(5):298‐303. - PubMed
Naspitz 1992 {published data only}
    1. Naspitz CK, Sole D. Treatment of acute wheezing and dyspnea attacks in children under 2 years old: inhalation of fenoterol plus ipratropium bromide versus fenoterol. Journal of Asthma 1992;29(4):253‐8. - PubMed
Schuh 1992 {published data only}
    1. Schuh S, Johnson D, Canny G, Reisman J, Shields M, Kovesi T, et al. Efficacy of adding nebulized ipratropium bromide to nebulized albuterol therapy in acute bronchiolitis. Pediatrics 1992;90(6):920‐3. - PubMed
Wang 1992 {published data only}
    1. Wang EE, Milner R, Allen U, Maj H. Bronchodilators for treatment of mild bronchiolitis: a factorial randomised trial. Archives of Disease in Childhood 1992;67(3):289‐93. - PMC - PubMed

References to studies excluded from this review

Chowdhury 1995 {published data only}
    1. Chowdhury D, Al‐Howasi M, Khalil M, Al‐Frayh AS, Chowdury S, Ramia S. The role of bronchodilators in the management of bronchiolitis: a clinical trial. Annals of Tropical Paediatrics 1995;15:77‐84. - PubMed
Henry 1983 {published data only}
    1. Henry RL, Milner AD, Stokes GM. Ineffectiveness of ipratropium bromide in acute bronchiolitis. Archives of Disease in Childhood 1983;58(11):925‐6. - PMC - PubMed
Huls 1990 {published data only}
    1. Hüls G, Bultmann C, Scheunemann C, Lindermann H. Effects of bronchodilator agents in acute obstructive bronchitis in early childhood [Zur Wirkung bronchodilatierender Substanzen bei der akuten obstruktiven Bonchitis im frühen Kindesalter]. Pneumologie 1990;44:1188‐9. - PubMed
Mallol 1987c {published data only}
    1. Mallol J, Munoz R, Puppo H, Ulloa V, Toro O, Girardi G, Barrueto L. Effects of nebulized fenoterol, associated with ipratropium or steroids, on the heart rate of infants under one year of age with acute wheezing. Pediatric Pulmonology 1987;3(2):83‐5. - PubMed
Mikawa 1997 {published data only}
    1. Mikawa H, Baba M, Nakashima M. Clinical usefulness of a leukotriene antagonist; pranlukast dry syrup on pediatric bronchial asthma in multicenter comparative double‐blind clinical study with oxatomide dry syrup. Journal of Clinical Therapeutics and Medicines 1997;13(2):423‐56.
Riedler 1990 {published data only}
    1. Riedler J. Inhalation bronchodilators in infancy‐‐comparative study between salbutamol and ipratropium bromide. Pneumologie 1990;44(5):777‐80. - PubMed
Stokes 1983 {published data only}
    1. Stokes GM, Milner AD, Hodges IG, Henry RL. Nebulised ipratropium bromide in wheezy infants and young children. European Journal of Respiratory Diseases ‐ Supplement 1983;128(2):494‐8. - PubMed
Stokes 1983b {published data only}
    1. Stokes GM, Milner AD, Hodges IG, Henry RL, Elphic MC. Nebulised therapy in acute severe bronchiolitis in infancy. Archives of Disease in Childhood 1983;58(4):279‐82. - PMC - PubMed
Wesley 1990 {published data only}
    1. Wesley AG, Paruk F, Broughton MH, Gouws E. Ipratropium bromide delivered by metered‐dose aerosol to infant wheezers. South African Medical Journal 1991;79:536‐8. - PubMed
Yuksel 2001 {published data only}
    1. Yuksel H, Coskun S, Polat M, Onag A. Lower arrythmogenic risk of low dose albuterol plus ipratropium. Indian Journal of Pediatrics 2001;68(10):945‐9. - PubMed

MeSH terms