Guideline 63 - Supporting Material

	Guideline topic: Pharmacological management of asthma Evidence table 4.3f: Anti-cholinergic therapy for exercise-induced asthma
Author		Year	Study type	Quality rating	Population	Outomes measured	Effect size	Confidence intervals / p values	Comments
Boulet		1989	Randomised, double-blind, placebo, cross-over. Single dosing with salbutamol 200ug. Ipratropium 80ug and cromoglycate 4mg.	++	11 adults with asthma, aged 19-49 years	Exercise and hyperosmolar induced bronchoconstriction % protection exercise:	Cromoglycate: 35% Ipratropium: 54% Salbutamol: 71%	Vs placebo: p< 0.05 p< 0.05 p< 0.05	Although all 3 drugs provided protection against EIA compared to placebo, there was no difference between drugs.
Bundgaard		1980	Randomised, double-blind, placebo, cross-over. Single dosing with neb. Cromoglycate 20mg, fenoterol 2mg, ipratropium 0.5mg and cromoglycate plus ipratropium.	+	18 adults with asthma, aged 17-40	Exercise-induced bronchoconstriction % fall in PEF:	Placebo 22% Ipratropium: 24% Cromoglycate: 20% Ipratropium cromoglycate: 13% Fenoterol: 2%	NS NS p< 0.05 p< 0.05	Ipratropim alone had no significant protection against EIA compared to placebo. There was some benefit when combined to cromoglycate.
Hartley		1980	Randomised, single-blind, placebo, cross-over	+	10 adults with asthma	Exercise-induced bronchoconstriction % fall in FEV1:	PLACEBO: 22% Ipratropium 0.1mg: 20% Ipratropium 1mg: 13%	NS p< 0.05	Only ipratropium 1mg provided partial protection against EIA.
Larsson		1982	Randomised, double-blind, placebo, cross-over. Single dosing with oxitropium 100ug, ipratropium 40ug, fenoterol 400ug.	++	8 adults with asthma	Exercise-induced bronchoconstriction FEV1	Fenoterol completely prevented EIA; there was no difference between Ipratropium oxitropium and placebo (illustrated in Figure)		Small numbers. Ipratropium and oxitropium had no effect on EIA.
Sanguinetti		1986	Randomised, double-blind, placebo, cross-over. Single dosing with fenoterol 200ug, 400ug or 200ug plus ipratropium 80ug.	++	12 asthma patients, aged 7-41 years	Exercise-induced bronchoconstriction Post-exercise FEV1 (% of baseline):	Placebo: 73% Fenoterol 200ug: 80% Fenoetrol 400ug: 84% Fen + ipratrop: 81%	NS p< 0.05 NS	Lack of effect with Duovent could be due to under-powered study.
Taytard		1987	Randomised, double-blind, placebo, cross-over. Single dosing with oxitropium 300ug	++	10 adults with asthma, anged 15-26 years	Exercise-induced bronchoconstriction T25 FEV1: T25 FEF 25-75:	p< 0.01 p< 0.01	Oxitropium 300ug prevented EIA compared to placebo.
Wolkove		1981	Randomised, double-blind, placebo, cross-over. Single dosing with ipratropium 40ug.	++	8 adults with asthma	Exercise-induced bronchoconstriction FEV1% FEF %	Placebo vs ipratropium: Illustrated in Figure.	NS NS	Small numbers. Ipratropium 40ug had no significant protection against EIA

Boulet LP, Turcotte H, Tennina S. Comparative efficacy of salbutamol, ipratropium, and cromoglycate in the prevention of bronchospasm induced by exercise and hyperosmolar challenges. J Allergy Clin Immunol 1989;83(5):882-7.
Bundgaard A, Rasmussen FV, Madsen L. Pretreatment of exercise-induced asthma in adults with aerosols and pulverized tablets. Allergy 1980;35(8):639-45.
Hartley JP, Davies BH. Cholinergic blockade in the prevention of exercise-induced asthma. Thorax 1980;35(9):680-5.
Larsson K. Oxitropium bromide, ipratropium bromide and fenoterol in exercise-induced asthma. Respiration 1982;43(1):57-63.
Sanguinetti CM, De Luca S, Gasparini S, Massei V. Evaluation of Duovent in the prevention of exercise-induced asthma. Respiration 1986;50(Suppl 2):181-5.
Taytard A, Vergeret J, Guenard H, Vaida P, Bellvert P, Freour P. Prevention of exercise-induced asthma by oxitropium bromide. Eur J Clin Pharmacol 1987;33(5):455-8.
Wolkove N, Kreisman H, Frank H, Gent M. The effect of ipratropium on exercise-induced bronchoconstriction. Ann Allergy 1981;47(5 Pt 1):311-5.

Guideline topic: Pharmacological management of asthma Evidence table 4.3f: Anti-cholinergic therapy for exercise-induced asthma

Guideline topic: Pharmacological management of asthma
Evidence table 4.3f: Anti-cholinergic therapy for exercise-induced asthma