BNF for Children 2011-2012

BNFC 2011–2012 1333 Respiratory system3.1 Bronchodilators 1333.1.1 Adrenoceptor agonists 1373.1.1.1 Selective beta 2 agonists 1373.1.1.2 Other adrenoceptor agonists 1413.1.2 Antimuscarinic bronchodilators 1413.1.3 Theophylline 1423.1.4 Compound bronchodilator preparations1443.1.5 Peak flow meters, inhalerdevices, and nebulisers 1443.2 Corticosteroids 1463.3 Cromoglicate and related therapyand leukotriene receptorantagonists 1513.3.1 Cromoglicate and related therapy1513.3.2 Leukotriene receptor antagonists1523.4 Antihistamines, immunotherapy,and allergic emergencies 1533.4.1 Antihistamines 1533.4.2 Allergen immunotherapy 1573.4.3 Allergic emergencies 1593.5 Respiratory stimulants andpulmonary surfactants 1623.5.1 Respiratory stimulants 1623.5.2 Pulmonary surfactants 1623.6 Oxygen 1633.7 Mucolytics 1653.8 Aromatic inhalations 1663.9 Cough preparations 1673.9.1 Cough suppressants 1673.9.2 Expectorant and demulcentcough preparations 1673.10 Systemic nasal decongestants 168This chapter includes advice on the drug managementof the following:acute asthma, p. 134anaphylaxis, p. 159angioedema, p. 161chronic asthma, p. 135croup, p. 1373.1 Bronchodilators3.1.1 Adrenoceptor agonists3.1.2 Antimuscarinic bronchodilators3.1.3 Theophylline3.1.4 Compound bronchodilatorpreparations3.1.5 Peak flow meters, inhaler devices, andnebulisersAsthmaDrugs used in the management of asthma include beta 2agonists (section 3.1.1), antimuscarinic bronchodilators(section 3.1.2), theophylline (section 3.1.3), corticosteroids(section 3.2), cromoglicate and nedocromil (section3.3.1), leukotriene receptor antagonists (section 3.3.2),and in specialist centres, omalizumab (section 3.4.2).For tables outlining the management of chronic asthmaand management of acute asthma, see p. 135 andp. 136.Administration of drugs for asthmaInhalation This route delivers the drug directly to theairways; the dose required is smaller than when given bymouth and side-effects are reduced. See Inhaler devices,section 3.1.5.Solutions for nebulisation for use in acute severeasthma are administered over 5–10 minutes from anebuliser, usually driven by oxygen in hospital. SeeNebulisers, section 3.1.5.Oral Systemic side-effects occur more frequently whena drug is given orally rather than by inhalation. Oralcorticosteroids, theophylline, and leukotriene receptorantagonists are sometimes required for the managementof asthma. Oral administration of a beta 2 agonistis generally not recommended for children, but may benecessary in infants and young children who are unableor unwilling to use an inhaler device.Parenteral Drugs such as beta 2 agonists, corticosteroids,and aminophylline can be given by injection inacute severe asthma when drug administration by nebulisationis inadequate or inappropriate; in these circumstancesthe child should generally be treated in a highdependencyor intensive care unit.3 Respiratory systemPregnancy and breast-feedingWomen with asthma should be closely monitored duringpregnancy. Well-controlled asthma has no importanteffects on pregnancy, labour, or the fetus. Drugs for