Treatment with inhaled short-acting anticholinergics (SAAC) and short-acting beta-2 agonists (SABA) decreased hospitalization rates and improved pulmonary function in adults presenting to the emergency department with acute asthma, according to a Cochrane systematic review.

Although SAAC and SABA are effective for adults with acute asthma who present to the emergency department, it is not certain whether the combination is more effective in reducing hospitalizations vs. SABA alone. 

Researchers performed a systematic search and meta-analysis on the efficacy of combined SAAC + SABA therapy vs. SABA alone using various databases from 1946 to July 2015. They included randomized or controlled clinical trials comparing the efficacy of SAAC and SABA vs. SABA alone. Twenty-three studies involving 2,724 patients were analyzed; most studies had an unclear or high risk of bias.  

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Moderate quality data indicated patients receiving the combination inhaled therapy were less likely to be hospitalized (risk ratio [RR] 0.72, 95% CI: 0.59–0.87). Combination inhaled therapy was more effective than SABA alone for reducing hospitalization in patients with severe asthma exacerbations but was not found for patients with mild or moderate exacerbations (P=0.02). 

Additional data indicated patients receiving combination therapy were more likely to have improved forced expiratory volume in 1 second (FEV1; low quality evidence), peak expiratory flow (PEF; very low quality evidence), increased percent change in PEF from baseline (moderate quality evidence), and were less likely to return to the emergency department for additional care (RR 0.80, 95% CI: 0.66–0.98; moderate quality evidence) vs. patients receiving SABA alone.

However, patients receiving combination therapy were more likely to experience adverse effects vs. treatment with SABA alone (odds ratio [OR] 2.03, 95% CI: 1.28–3.2; moderate quality evidence). Adverse events included tremor, agitation, and palpitations.

Study authors were able to conclude that combination inhaled therapy with SAAC + SABA was more effective in preventing hospitalization in adults with severe asthma exacerbations vs. mild-moderate asthma exacerbations. 

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