Drug Summaries – Humza Ibrahim
7.2.1 Desensitising vaccines.......................... 7
Chapter 3 8 Cough and congestion ......................................... 7
Respiratory system 8.1 Aromatic inhalations .................................... 7
8.2 Cough preparations ..................................... 7
TABLE OF CONTENTS 8.3 OTC Cough preparations .............................. 7
Table of Contents ......................................................... 1
1 Asthma ................................................................. 2
1.1 Management of chronic asthma .................. 2
1.1.1 Children under 5 years (BTS/SIGN
Guidelines) ........................................................... 2
1.1.2 Adult and child over 5 years (BTS/SIGN
Guidelines) ........................................................... 2
1.2 Management of acute asthma ..................... 2
2 Croup .................................................................... 3
3 COPD .................................................................... 3
4 Bronchodilators.................................................... 4
4.1 Selective beta2 agonists ............................... 4
4.1.1 Short-acting beta2 agonists ................. 4
4.1.2 Long-acting beta2 agonists .................. 4
4.2 Antimuscarinics ............................................ 4
4.2.1 Ipratropium bromide ........................... 4
4.2.2 Theophylline (high risk) ....................... 4
4.2.3 Warning signs ....................................... 4
4.2.4 Monitoring ........................................... 5
4.2.5 Interactions .......................................... 5
4.2.6 Pregnancy and breastfeeding .............. 5
4.2.7 Maintaining the same brand ................ 5
5 Leukotriene receptor antagonists ........................ 5
6 Corticosteroids ..................................................... 5
6.1 Asthma ......................................................... 5
6.2 COPD ............................................................ 5
6.3 Cautions ....................................................... 5
6.4 Side effects ................................................... 6
6.5 Beclometasone diproprionate ..................... 6
7 Allergic conditions ................................................ 6
7.1 Antihistamines ............................................. 6
7.1.1 Hydroxyzine: risk of QT-interval
prolongation and Torsade de Pointes .................. 7
7.2 Allergen immunotherapy ............................. 7
Chapter 3 – Pg 1
Compiled using the British National Formulary
, Drug Summaries – Humza Ibrahim
reduced bone mineral density, and adrenal
Chapter 3 suppression.
Respiratory system Monitor eyes for cataracts, and weight and height for
growth.
1.1.2 Adult and child over 5 years (BTS/SIGN
1 ASTHMA Guidelines)
Complete control of asthma is defined as no daytime 1. Mild intermittent asthma
symptoms, no night-time awakening due to asthma, Inhaled short-acting beta2 agonist
no asthma attacks, no need for rescue medication, no 2. Regular preventer therapy
limitations on activity including exercise, and normal a. Add inhaled corticosteroid (ICS), or
lung function. b. Add LTRA or theophylline if child unable to
take ICS (not as effective)
Pregnancy and breast-feeding 3. Initial add-on therapy
Severe acute attacks of asthma can have an adverse a. Add regular inhaled long-acting beta2
effect on pregnancy and should be treated promptly agonist (LABA) (formoterol or salmeterol)
in hospital with conventional therapy, therefore b. No response to the LABA, discontinue and
women with asthma should be treated as normal and increase dose of inhaled corticosteroid,
closely monitored during pregnancy. c. consider trial of a LTRA or m/r theophylline
4. Persistent poor control
1.1 MANAGEMENT OF CHRONIC ASTHMA a. Increase ICS to max dose
b. consider adding fourth drug LTRA, m/r
Lifestyle changes
theophylline, modified-release beta2 agonist
Weight loss in overweight patients; smoking
5. Continuous use of oral corticosteroids
cessation; breathing exercises
a. Refer to specialist care
Exercise-induced Asthma b. Initiated on regular oral corticosteroid
Usually indicates poorly controlled asthma, treatment
may need stepping up
1.2 MANAGEMENT OF ACUTE ASTHMA
Stepping down Management
To avoid unwanted side effects and unnecessary 1. High flow oxygen (40-60%) to maintain a SpO2
costs, treatment is gradually stepped down every level between 94–98%
three months (25–50% each time) once control is 2. beta2 agonist administered by an oxygen-driven
achieved. Patients should be maintained at the lowest nebuliser (to avoid pulmonary O2 displacement)
possible dose of inhaled corticosteroid. 3. oral prednisolone once daily for at least 5 days or
until recovery
1.1.1 Children under 5 years (BTS/SIGN Guidelines) 4. Can add the following if no improvement:
1. Mild intermittent asthma a. nebulised ipratropium bromide
Inhaled short-acting beta2 agonist (such as b. intravenous dose of magnesium sulfate
salbutamol or terbutaline) c. intravenous aminophylline (caution if
2. Regular preventer therapy patient already on theophylline)
a. Add inhaled corticosteroid (ICS), or
b. Add leukotriene receptor antagonist (LTRA) Moderate acute asthma
if child unable to take ICS (not as effective) • Increasing symptoms
3. Initial add-on therapy
• Peak flow > 50–75% best or predicted
a. 2–5 years, add LTRA or ICS
• No features of acute severe asthma
b. under 2 years, proceed to step 4
4. Persistent poor control Severe acute asthma
refer to respiratory paediatrician Any one of the following:
• Peak flow 33–50% best or predicted
Steroid card should be issued for high doses,
• Respiratory rate ≥ 25/min
especially in children where high doses are associated
• Heart rate ≥ 110/min
with systemic side-effects, including growth failure,
• Inability to complete sentences in one breath
Chapter 3 – Pg 2
Compiled using the British National Formulary
7.2.1 Desensitising vaccines.......................... 7
Chapter 3 8 Cough and congestion ......................................... 7
Respiratory system 8.1 Aromatic inhalations .................................... 7
8.2 Cough preparations ..................................... 7
TABLE OF CONTENTS 8.3 OTC Cough preparations .............................. 7
Table of Contents ......................................................... 1
1 Asthma ................................................................. 2
1.1 Management of chronic asthma .................. 2
1.1.1 Children under 5 years (BTS/SIGN
Guidelines) ........................................................... 2
1.1.2 Adult and child over 5 years (BTS/SIGN
Guidelines) ........................................................... 2
1.2 Management of acute asthma ..................... 2
2 Croup .................................................................... 3
3 COPD .................................................................... 3
4 Bronchodilators.................................................... 4
4.1 Selective beta2 agonists ............................... 4
4.1.1 Short-acting beta2 agonists ................. 4
4.1.2 Long-acting beta2 agonists .................. 4
4.2 Antimuscarinics ............................................ 4
4.2.1 Ipratropium bromide ........................... 4
4.2.2 Theophylline (high risk) ....................... 4
4.2.3 Warning signs ....................................... 4
4.2.4 Monitoring ........................................... 5
4.2.5 Interactions .......................................... 5
4.2.6 Pregnancy and breastfeeding .............. 5
4.2.7 Maintaining the same brand ................ 5
5 Leukotriene receptor antagonists ........................ 5
6 Corticosteroids ..................................................... 5
6.1 Asthma ......................................................... 5
6.2 COPD ............................................................ 5
6.3 Cautions ....................................................... 5
6.4 Side effects ................................................... 6
6.5 Beclometasone diproprionate ..................... 6
7 Allergic conditions ................................................ 6
7.1 Antihistamines ............................................. 6
7.1.1 Hydroxyzine: risk of QT-interval
prolongation and Torsade de Pointes .................. 7
7.2 Allergen immunotherapy ............................. 7
Chapter 3 – Pg 1
Compiled using the British National Formulary
, Drug Summaries – Humza Ibrahim
reduced bone mineral density, and adrenal
Chapter 3 suppression.
Respiratory system Monitor eyes for cataracts, and weight and height for
growth.
1.1.2 Adult and child over 5 years (BTS/SIGN
1 ASTHMA Guidelines)
Complete control of asthma is defined as no daytime 1. Mild intermittent asthma
symptoms, no night-time awakening due to asthma, Inhaled short-acting beta2 agonist
no asthma attacks, no need for rescue medication, no 2. Regular preventer therapy
limitations on activity including exercise, and normal a. Add inhaled corticosteroid (ICS), or
lung function. b. Add LTRA or theophylline if child unable to
take ICS (not as effective)
Pregnancy and breast-feeding 3. Initial add-on therapy
Severe acute attacks of asthma can have an adverse a. Add regular inhaled long-acting beta2
effect on pregnancy and should be treated promptly agonist (LABA) (formoterol or salmeterol)
in hospital with conventional therapy, therefore b. No response to the LABA, discontinue and
women with asthma should be treated as normal and increase dose of inhaled corticosteroid,
closely monitored during pregnancy. c. consider trial of a LTRA or m/r theophylline
4. Persistent poor control
1.1 MANAGEMENT OF CHRONIC ASTHMA a. Increase ICS to max dose
b. consider adding fourth drug LTRA, m/r
Lifestyle changes
theophylline, modified-release beta2 agonist
Weight loss in overweight patients; smoking
5. Continuous use of oral corticosteroids
cessation; breathing exercises
a. Refer to specialist care
Exercise-induced Asthma b. Initiated on regular oral corticosteroid
Usually indicates poorly controlled asthma, treatment
may need stepping up
1.2 MANAGEMENT OF ACUTE ASTHMA
Stepping down Management
To avoid unwanted side effects and unnecessary 1. High flow oxygen (40-60%) to maintain a SpO2
costs, treatment is gradually stepped down every level between 94–98%
three months (25–50% each time) once control is 2. beta2 agonist administered by an oxygen-driven
achieved. Patients should be maintained at the lowest nebuliser (to avoid pulmonary O2 displacement)
possible dose of inhaled corticosteroid. 3. oral prednisolone once daily for at least 5 days or
until recovery
1.1.1 Children under 5 years (BTS/SIGN Guidelines) 4. Can add the following if no improvement:
1. Mild intermittent asthma a. nebulised ipratropium bromide
Inhaled short-acting beta2 agonist (such as b. intravenous dose of magnesium sulfate
salbutamol or terbutaline) c. intravenous aminophylline (caution if
2. Regular preventer therapy patient already on theophylline)
a. Add inhaled corticosteroid (ICS), or
b. Add leukotriene receptor antagonist (LTRA) Moderate acute asthma
if child unable to take ICS (not as effective) • Increasing symptoms
3. Initial add-on therapy
• Peak flow > 50–75% best or predicted
a. 2–5 years, add LTRA or ICS
• No features of acute severe asthma
b. under 2 years, proceed to step 4
4. Persistent poor control Severe acute asthma
refer to respiratory paediatrician Any one of the following:
• Peak flow 33–50% best or predicted
Steroid card should be issued for high doses,
• Respiratory rate ≥ 25/min
especially in children where high doses are associated
• Heart rate ≥ 110/min
with systemic side-effects, including growth failure,
• Inability to complete sentences in one breath
Chapter 3 – Pg 2
Compiled using the British National Formulary
