Asthma and other recurrent wheezing disorders in children (acute)

Overview

Abstract | Cite as | Substantive changes

Abstract

INTRODUCTION: Acute childhood asthma is a common clinical emergency presenting across a range of ages and with a range of severities. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute asthma in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 35 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta2 agonists (high-dose nebulised, metered-dose inhaler plus spacer device versus nebuliser, intravenous), corticosteroids (systemic, high-dose inhaled), ipratropium bromide (single- or multiple-dose inhaled), magnesium sulphate, oxygen, and theophylline or aminophylline.

Cite as

Okpapi A, Friend AJ and Turner SW. Asthma and other recurrent wheezing disorders in children (acute). Clinical Evidence 2012; 07:.

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Substantive changes

Beta2 agonists (high-dose inhaled) Search updated for one already included systematic review comparing continuous versus intermittent nebulised beta2 agonist administration; no new studies found.[10] Search updated for another already included systematic review comparing a spacer/holding chamber attached to a metered-dose inhaler versus nebuliser for delivery of beta2 agonists; new evidence added.[12] Categorisation unchanged (Beneficial).

Ipratropium bromide (inhaled) added to beta2 agonists New evidence added[16][17][19] and option restructured. Existing evidence re-evaluated. Categorised as Beneficial.

Corticosteroids (systemic) Search updated for already included systematic review comparing high-dose nebulised corticosteroid versus oral corticosteroids; new evidence added.[25] New evidence added.[26] Categorisation unchanged (Beneficial).

Corticosteroids (high-dose inhaled) Search updated for already included systematic review; new evidence added.[25] New evidence added.[26] Categorisation unchanged (Beneficial).

Theophylline (intravenous) Search updated for already included systematic review; no new evidence added.[35] New evidence added.[36][37] Categorisation unchanged (Likely to be beneficial)

Salbutamol (intravenous) New option added.[19][38][40] Categorised as Beneficial.

Magnesium sulphate (intravenous) New option added.[39][42][43] Categorised as Beneficial.

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