Long-acting muscarinic antagonists as add-on treatment for asthma in children under age 12: a systematic review and meta-analysis.

Introduction: Children under 12 have fewer treatment options for uncontrolled asthma than adolescents and adults. Long-acting muscarinic antagonists (LAMA) can be used as an add-on therapy for asthma in adults, but the evidence in children is unclear.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies that evaluated LAMA as an add-on therapy to inhaled corticosteroids in asthmatic children younger than 12. We performed a random-effects meta-analysis for lung function, asthma control, and adverse events. Subgroup analyses were performed for different LAMA dosages.

Results: Four RCTs and two observational studies (n = 1210) were included in our systematic review. The pulmonary function tests indicated that LAMA at any dose significantly improved peak FEV1 (MD 86.16 mL; 95 %CI 18.62-153.71; p < 0.01) and FEF25-75 % (MD 0.2518L; 95 %CI 0.1971-0.3064; p < 0.01), while FVC (MD 9.69 mL; 95 %CI -34.57 to 53.95; p = 0.67) remained unchanged. Asthma control measured by the Asthma Control Questionnaire (MD -0.07; 95 %CI -0.08 to -0.06; p < 0.01) also favoured LAMA treatments. Nighttime awakenings and rescue treatment usage showed no significant differences between groups. Using LAMA was also associated with fewer adverse events (RR 0.88; 95 %CI 0.79-0.98; p = 0.021).

Conclusion: LAMA are safe and effective for moderate/severe asthma for children aged 6-11. Evidence is still slowly evolving for children younger than 6 years.