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Ipratropium bromide versus long‐acting beta‐2 agonists for stable chronic obstructive pulmonary disease

This review looks at studies that compare the regular use for at least four weeks of different types of bronchodilator medicine (long acting beta‐2 agonist medicines and ipratropium) in people with stable chronic obstructive pulmonary disease (COPD, or emphysema/chronic bronchitis).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Inhaled short‐acting beta2‐agonists versus ipratropium for acute exacerbations of chronic obstructive pulmonary disease

During an acute worsening of chronic obstructive pulmonary disease, there may be a worsening in airway function. Two different types of drugs may be given as inhaled therapy to improve this: anticholinergic drugs such as ipratropium and beta2‐agonists. These days the drugs of the latter type that are used for acute COPD are salbutamol and terbutaline, but neither of these drugs have been used in the only studies that we could find. We found only three small studies. Overall, both types of drug showed a small but worthwhile effect. There was no difference between them. Our review was not designed to test whether they would have had a greater effect if both were given at the same time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Ipratropium bromide versus short acting beta‐2 agonists for stable chronic obstructive pulmonary disease

This review looks at studies that compare the regular use for at least four weeks of different types of inhaled short‐acting bronchodilator medication in people with chronic obstructive pulmonary disease (COPD, or emphysema/chronic bronchitis). There were eleven trials included. There were no major differences seen between the responses to ipratropium and salbutamol, or the combination. Where there were benefits, they were small and would not support a general recommendation for the use of ipratropium bromide or a combination with beta‐2 agonist over a beta‐2 agonist alone in COPD. People with COPD could use the short‐acting bronchodilator that gives them the most improvement in their symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Anticholinergic therapy for acute asthma in children

Asthma is a condition that affects the airways (tubes carrying air in and out of the lungs). During an asthma exacerbation (attack), the airways narrow and drugs can be taken to dilate, or widen, the airways. Common bronchodilators (medicines used to widen the airways) are short‐acting beta2‐ agonists (e.g. salbutamol) or anticholinergics (e.g. ipratropium bromide). In this review, we examined if the use of anticholinergic inhalers during an asthma attack in children aged over two years is effective compared to either placebo or another bronchodilator. We also looked at combinations of anticholinergic plus a beta2‐agonist compared to an anticholinergic on its own.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Inhaled drugs to open up the airways of people with cystic fibrosis

People with cystic fibrosis are often given drugs to open up their airways when they are breathless or wheezy. The drugs are given either by metered dose inhalers or nebulisers. We looked at how well these drugs worked in both children and adults. We included 18 trials in the review. Some of these used beta‐2 agonist bronchodilators and some used anticholinergic bronchodilators. Data for both long‐acting and short‐acting versions of both drug classes were collected. The results were split into short‐term effects (less than one week) and long‐term effects (one week or longer). The studies were too varied to allow results to be combined. Both short‐acting and long‐acting beta‐2 agonists improved lung function in the short‐term, but only in those people whose airways were found to be sensitive to the bronchodilator after their first dose. Results were not consistent in the long‐term. It is reasonable to suggest that a long‐term trial of inhaled bronchodilators be considered before their long‐term use is recommended. Further large trials are needed to make clear the benefits of these drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Addition of intravenous beta2‐agonists to inhaled beta2‐agonists for acute asthma

We found three trials involving 104 people (75 children and 29 adults) with acute asthma. There was no significant difference in adults receiving intravenous beta‐agonists as well as standard care in the one small trial considering this comparison. We also looked at length of stay in the emergency department. Two reported shorter recovery time or quicker discharge from the emergency department in patients also receiving intravenous beta‐agonists. One trial reported that more children experienced tremor if they had received injected beta‐agonists whereas another trial, with adults, reported no significant difference in adverse effects. As there are so few trials and so few included patients we cannot be sure about the reliability of these findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drug Class Review: Controller Medications for Asthma: Final Update 1 Report [Internet]

To compare the efficacy and safety of inhaled corticosteroids (ICSs), long-acting beta-2 agonists (LABAs), leukotriene modifiers (LMs), anti-IgE therapy, combination products, and tiotropium for people with persistent asthma.

Drug Class Reviews - Oregon Health & Science University.

Version: April 2011
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Does tiotropium lower exacerbation and hospitalization frequency in COPD patients? Results of a meta-analysis

The authors concluded that tiotropium reduced the number of exacerbations and hospitalisations of chronic obstructive pulmonary disease (COPD) patients compared with placebo and ipratropium; compared with salmeterol, only the exacerbation frequency was reduced. Given the variability across trials, the possibility of inappropriate pooling and the poor quality of the evidence base, the authors’ conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Exercise-Induced Bronchoconstriction and Asthma

The objectives are: (1) to assess diagnostic test characteristics of six alternative index tests compared with the selected reference standard-a standardized exercise challenge test (ECT) in patients with suspected exercise-induced bronchoconstriction or asthma (EIB/EIA); (2) to determine the efficacy of a single prophylactic dose of four pharmacologic and one nonpharmacologic interventions versus placebo to attenuate EIB/EIA in patients with diagnosed EIB/EIA; and (3) to determine if regular daily treatment with short-acting or long-acting beta-agonists (SABA or LABA) causes patients with EIA to develop tachyphylaxis when additional prophylactic doses are used pre-exercise.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: January 2010
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Lactose Intolerance and Health

We systematically reviewed evidence to determine lactose intolerance (LI) prevalence, bone health after dairy-exclusion diets, tolerable dose of lactose in subjects with diagnosed LI, and management.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: February 2010
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Standardized Allergenic Extract, Timothy grass (Phleum pratense) (GRASTEK) (sublingual tablet 2,800 BAU) [Internet]

The objective is to conduct a systematic review of the beneficial and harmful effects of Timothy grass (Phleum pratense) standardized allergenic extract (PPAE; brand name Grastek) 2,800 BAU, for the treatment of Timothy and related grass pollen–induced allergic rhinitis (AR), with or without conjunctivitis, in adults and children aged five years and older.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: December 2014

Tiotropium for treatment of stable COPD: a meta-analysis of clinically relevant outcomes

The review found that, compared with placebo or ipratropium, tiotropium improved the quality of life, eased difficulties with breathing, and reduced exacerbations and related hospitalisations in patients with stable chronic obstructive pulmonary disease. The authors' conclusions reflect the evidence base, but because of potential publication and language bias, the conclusions should be considered tentative.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Drug Class Review: Quick-relief Medications for Asthma: Final Report Update 1 [Internet]

Asthma is a chronic inflammatory disorder of the airways. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, cough, and other symptoms. Asthma medications fall into 2 general classes: medications for long-term control and medications for quick relief of airflow obstruction and symptoms. Medications for quick relief of bronchoconstriction and acute symptoms include short-acting beta2-agonists and anticholinergics. The purpose of this review is to compare the benefits and harms of short-acting beta2-agonists and ipratropium bromide used for quick relief of asthma symptoms.

Drug Class Reviews - Oregon Health & Science University.

Version: October 2008
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Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness [Internet]

To examine evidence for whether breathing exercises and retraining techniques lead to improvements in asthma symptoms, reductions in asthma medication use, improved quality of life, or improved pulmonary function in asthma sufferers.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: September 2012
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Helium‐oxygen mixture for the treatment of exacerbations of chronic obstructive pulmonary disease

Mixtures of helium and oxygen (heliox) may make breathing easier, but there is not enough evidence from trials to show whether these mixtures can relieve attacks of COPD (chronic obstructive pulmonary disease).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Are inhaled anticholinergics added to β2‐agonists beneficial in children hospitalised with acute asthma?

Background: Anticholinergics (e.g. ipratropium bromide, atropine sulfate) are inhaled drugs. They relax the airway muscles and decrease secretions. Anticholinergics are sometimes used in addition to beta2‐agonists (such as salbutamol and terbutaline), which are potent drugs given to relax smooth muscles in the airways in children with acute asthma. We do not know whether the addition of inhaled anticholinergics to beta2‐agonists is beneficial for children hospitalised with acute asthma.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force [Internet]

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Fewer than half of the estimated 24 million Americans with airflow obstruction have received a COPD diagnosis, and diagnosis often occurs in advanced stages of the disease.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: March 2008
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Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care [Internet]

This guideline offers best practice advice on the identification and care of patients with chronic obstructive pulmonary disease (COPD). It aims to define the symptoms, signs and investigations required to establish a diagnosis of COPD. It also aims to define the factors that are necessary to assess its severity, provide prognostic information and guide best management. It gives guidance on the pharmacological and non-pharmacological treatment of patients with stable COPD, and on the management of exacerbations. The interface with surgery and intensive therapy units (ITU) are also discussed.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2010
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Treatments for Seasonal Allergic Rhinitis [Internet]

This review compared the effectiveness and common adverse events of medication classes used to treat seasonal allergic rhinitis (SAR) in adolescents and adults, in pregnant women, and in children. We sought to compare the following classes of drugs: oral and nasal antihistamines and decongestants; intranasal corticosteroids, mast cell stabilizers (cromolyn), and anticholinergics (ipratropium); oral leukotriene receptor antagonists (montelukast); and nasal saline.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: July 2013
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Drug Class Review: Nasal Corticosteroids: Final Report Update 1 [Internet]

Nasal corticosteroids are a safe and effective treatment option for both allergic and non-allergic rhinitis. There are currently 8 different nasal corticosteroid preparations on the U.S. market. The nasal sprays differ with respect to delivery device and propellant, as well as potency and dosing frequency. The purpose of this review is evaluating the comparative evidence on the benefits and harms of the nasal corticosteroids to help policy makers and clinicians make informed choices.

Drug Class Reviews - Oregon Health & Science University.

Version: June 2008
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