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

Diagnosis and treatment of bronchiolitis in F innish and S wedish children's hospitals

“…In the present study, inhaled corticosteroids were seen as an option in some hospitals in both countries, though not effective in bronchiolitis according to many studies and systematic reviews . On the other hand, the combined use of oral dexamethasone and inhaled adrenaline reduced the need for hospitalisation in two randomised controlled studies performed in paediatric emergency rooms , but the continuation of dexamethasone after the initial dose provided no additional benefits .…”

Diagnosis and treatment of bronchiolitis in F innish and S wedish children's hospitals

“…In the present study, inhaled corticosteroids were seen as an option in some hospitals in both countries, though not effective in bronchiolitis according to many studies and systematic reviews . On the other hand, the combined use of oral dexamethasone and inhaled adrenaline reduced the need for hospitalisation in two randomised controlled studies performed in paediatric emergency rooms , but the continuation of dexamethasone after the initial dose provided no additional benefits .…”

Paediatrics: how to manage acute asthma exacerbations

“…A systematic review and meta-analysis of 321 infants aged <2 years from six parallel control trials found a decreased need for additional treatment compared to salbutamol alone in an ED setting but no changes in the length of stay in hospitalized children, symptom improvement in ED or in the number of hospitalized patients. 69 Furthermore, the beneficial effects of ipratropium as an adjunct agent appear to decline with repeated doses. Numerous studies have found that ipratropium bromide with salbutamol in hospitalized children does not result in reduced lengths of stay or symptom improvements compared to salbutamol alone.…”

Pediatric respiratory distress: California out‐of‐hospital protocols and evidence‐based recommendations

“…According to our review, and in agreement with recent AAP guidelines, 10 there is a level A recommendation against the use of albuterol for bronchiolitis given that the incidence of adverse effects outweighs any potential benefits. Similarly, inhaled anticholinergics have not been shown to improve outcomes in wheezing children < 2 years of age 22,27 . An important caveat is that the AAP guideline “does not apply to children with immunodeficiencies…, children with recurrent history of wheezing, chronic neonatal lung disease (bronchopulmonary dysplasia), neuromuscular disease, cystic fibrosis, or those with hemodynamically significant congenital heart disease.” 8 Thus, if a pediatric patient < 24 months is in respiratory distress with wheezing, and history is unknown or unobtainable under the emergency circumstances, treatment with a dose of a beta‐agonist may not be contraindicated.…”

Diagnosis and treatment of bronchiolitis in F innish and S wedish children's hospitals

“…In the present study, inhaled corticosteroids were seen as an option in some hospitals in both countries, though not effective in bronchiolitis according to many studies and systematic reviews . On the other hand, the combined use of oral dexamethasone and inhaled adrenaline reduced the need for hospitalisation in two randomised controlled studies performed in paediatric emergency rooms , but the continuation of dexamethasone after the initial dose provided no additional benefits .…”

Paediatrics: how to manage acute asthma exacerbations

“…A systematic review and meta-analysis of 321 infants aged <2 years from six parallel control trials found a decreased need for additional treatment compared to salbutamol alone in an ED setting but no changes in the length of stay in hospitalized children, symptom improvement in ED or in the number of hospitalized patients. 69 Furthermore, the beneficial effects of ipratropium as an adjunct agent appear to decline with repeated doses. Numerous studies have found that ipratropium bromide with salbutamol in hospitalized children does not result in reduced lengths of stay or symptom improvements compared to salbutamol alone.…”

Pediatric respiratory distress: California out‐of‐hospital protocols and evidence‐based recommendations

“…According to our review, and in agreement with recent AAP guidelines, 10 there is a level A recommendation against the use of albuterol for bronchiolitis given that the incidence of adverse effects outweighs any potential benefits. Similarly, inhaled anticholinergics have not been shown to improve outcomes in wheezing children < 2 years of age 22,27 . An important caveat is that the AAP guideline “does not apply to children with immunodeficiencies…, children with recurrent history of wheezing, chronic neonatal lung disease (bronchopulmonary dysplasia), neuromuscular disease, cystic fibrosis, or those with hemodynamically significant congenital heart disease.” 8 Thus, if a pediatric patient < 24 months is in respiratory distress with wheezing, and history is unknown or unobtainable under the emergency circumstances, treatment with a dose of a beta‐agonist may not be contraindicated.…”

Diagnosis and treatment of bronchiolitis in F innish and S wedish children's hospitals

“…In the present study, inhaled corticosteroids were seen as an option in some hospitals in both countries, though not effective in bronchiolitis according to many studies and systematic reviews . On the other hand, the combined use of oral dexamethasone and inhaled adrenaline reduced the need for hospitalisation in two randomised controlled studies performed in paediatric emergency rooms , but the continuation of dexamethasone after the initial dose provided no additional benefits .…”

Paediatrics: how to manage acute asthma exacerbations

“…A systematic review and meta-analysis of 321 infants aged <2 years from six parallel control trials found a decreased need for additional treatment compared to salbutamol alone in an ED setting but no changes in the length of stay in hospitalized children, symptom improvement in ED or in the number of hospitalized patients. 69 Furthermore, the beneficial effects of ipratropium as an adjunct agent appear to decline with repeated doses. Numerous studies have found that ipratropium bromide with salbutamol in hospitalized children does not result in reduced lengths of stay or symptom improvements compared to salbutamol alone.…”

Pediatric respiratory distress: California out‐of‐hospital protocols and evidence‐based recommendations

“…According to our review, and in agreement with recent AAP guidelines, 10 there is a level A recommendation against the use of albuterol for bronchiolitis given that the incidence of adverse effects outweighs any potential benefits. Similarly, inhaled anticholinergics have not been shown to improve outcomes in wheezing children < 2 years of age 22,27 . An important caveat is that the AAP guideline “does not apply to children with immunodeficiencies…, children with recurrent history of wheezing, chronic neonatal lung disease (bronchopulmonary dysplasia), neuromuscular disease, cystic fibrosis, or those with hemodynamically significant congenital heart disease.” 8 Thus, if a pediatric patient < 24 months is in respiratory distress with wheezing, and history is unknown or unobtainable under the emergency circumstances, treatment with a dose of a beta‐agonist may not be contraindicated.…”