BNF for Children 2011-2012

144 3.1.4 Compound bronchodilator preparations BNFC 2011–20123 Respiratory systemNeonatal apnoea (but see notes above). By intravenous injection over 20 minutesNeonate initially 6 mg/kg, then 2.5 mg/kg every12 hours (increased if necessary to 3.5 mg/kgevery 12 hours)Note Plasma-theophylline concentration for optimumresponse in neonatal apnoea 8–12 mg/litre (44–66 micromol/litre),see also notes aboveAdministration For intravenous infusion, dilute to aconcentration of 1 mg/mL with Glucose 5% or SodiumChloride 0.9%Aminophylline (Non-proprietary) AInjection, aminophylline 25 mg/mL, net price 10-mLamp = 84pInjection, aminophylline 2 mg/mL, 20-mL amp;5 mg/mL, 20-mL ampAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Modified releaseNote Advice about modified-release theophylline preparationson p. 143 also applies to modified-release aminophylline preparationsPhyllocontin Continus c (Napp)Tablets, m/r, yellow, f/c, aminophylline hydrate225 mg, net price 56-tab pack = £2.39. Label: 25DoseChronic asthma (see also Management of ChronicAsthma, p. 135). By mouthChild body-weight over 40 kg initially 1 tablet twicedaily, increased after 1 week to 2 tablets twice dailyaccording to plasma-theophylline concentrationPeak flow meters may be used to assess lung function inchildren over 5 years with asthma, but symptom monitoringis the most reliable assessment of asthma control.They are best used for short periods to assess theseverity of asthma and to monitor response to treatment;continuous use of peak flow meters may detractfrom compliance with inhalers.Standard Range Peak Flow MeterConforms to standard EN ISO 23747: 2007AirZone c , range 60–720 litres/minute, net price = £4.50,replacement mouthpiece = 38p (Clement Clarke)Medi c , range 60–800 litres/minute, net price = £4.50(Medicare)MicroPeak c , range 60–800 litres/minute, net price = £6.50,replacement mouthpiece = 38p (Micro Medical)Mini-Wright c , range 60–800 litres/minute, net price = £6.86,replacement mouthpiece = 38p (Clement Clarke)Personal Best c , range 60–800 litres/minute, net price =£6.86, replacement mouthpiece = 25p (Respironics)Piko-1 c , range 15–999 litres/minute, net price = £9.50,replacement mouthpiece = 38p (nSPIRE Health)Pinnacle c , range 60–900 litres/minute, net price = £6.50(Fyne Dynamics)Pocketpeak c , range 60–800 litres/minute, net price = £6.53,replacement mouthpiece = 38p (nSPIRE Health)Vitalograph c , range 50–800 litres/minute, net price = £4.75(a child’s peak flow meter is also available), replacementmouthpiece = 40p (Vitalograph)Note Readings from new peak flow meters are often lower thanthose obtained from old Wright-scale peak flow meters and thecorrect recording chart should be usedLow Range Peak Flow MeterCompliant to standard EN ISO 23747: 2007 except forscale rangeMedi c , range 40–420 litres/minute, net price = £6.50(Medicare)Mini-Wright c , range 30–400 litres/minute, net price = £6.90,replacement mouthpiece = 38p (Clement Clarke)Pocketpeak c , range 50–400 litres/minute, net price = £6.53,replacement mouthpiece = 38p (nSPIRE Health)Note Readings from new peak flow meters are often lower thanthose obtained from old Wright-scale peak flow meters and thecorrect recording chart should be used3.1.4 Compound bronchodilatorpreparationsIn general, children are best treated with single-ingredientpreparations, such as a selective beta 2 agonist(section 3.1.1.1) or ipratropium bromide (section3.1.2), so that the dose of each drug can be adjusted.This flexibility is lost with compound bronchodilatorpreparations.3.1.5 Peak flow meters, inhalerdevices, and nebulisersPeak flow metersDrug delivery devicesInhaler devices A pressurised metered-dose inhaler isan effective method of drug administration in mild tomoderate chronic asthma; to deliver the drug effectively,a spacer device should also be used (see also NICEguidance, below). By the age of 3 years, a child canusually be taught to use a spacer device without a mask.As soon as a child is able to use the mouthpiece, thenthis is the preferred delivery system.Dry powder inhalers may be useful in children over 5years, who are unwilling or unable to use a pressurisedmetered-dose inhaler with a spacer device; breath-actuatedinhalers may be useful in older children if they areable to use the device effectively. The child or child’scarer should be instructed carefully on the use of theinhaler. It is important to check that the inhaler is beingused correctly; poor inhalation technique may be mistakenfor a lack of response to the drug.On changing from a pressurised metered-dose inhaler toa dry powder inhaler, the child may notice a lack ofsensation in the mouth and throat previously associatedwith each actuation; coughing may occur more frequentlyfollowing use of a dry-powder inhaler.CFC-free metered-dose inhalers should be cleanedweekly according to the manufacturer’s instructions.