page190
3 Respiratory system
3.1
Bronchodilators
170
3.1.1
Adrenoceptor agonists
175
3.1.1.1
Selective beta
2
agonists
175
3.1.1.2
Other adrenoceptor agonists
179
3.1.2
Antimuscarinic bronchodilators
179
3.1.3
Theophylline
181
3.1.4
Compound bronchodilator pre-
parations
182
3.1.5
Peak flow meters, inhaler
devices and nebulisers
182
3.2
Corticosteroids
184
3.3
Cromoglicate and related ther-
apy, leukotriene receptor
antagonists, and phosphodi-
esterase type-4 inhibitors
189
3.3.1
Cromoglicate and related ther-
apy
189
3.3.2
Leukotriene receptor antago-
nists
190
3.3.3
Phosphodiesterase type-4 inhi-
bitors
191
3.4
Antihistamines, hyposensi-
tisation, and allergic emergen-
cies
191
3.4.1
Antihistamines
191
3.4.2
Allergen Immunotherapy
195
3.4.3
Allergic emergencies
197
3.5
Respiratory stimulants and
pulmonary surfactants
199
3.5.1
Respiratory stimulants
199
3.5.2
Pulmonary surfactants
200
3.6
Oxygen
201
3.7
Mucolytics
202
3.8
Aromatic inhalations
203
3.9
Cough preparations
204
3.9.1
Cough suppressants
204
3.9.2
Demulcent and expectorant
cough preparations
205
3.10
Systemic nasal decongestants
205
This chapter also includes advice on the drug man-
agement of the following:
severe acute asthma,
p.
171
anaphylaxis,
p.
197
angioedema,
p.
199
chronic asthma,
p.
172
chronic obstructive pulmonary disease,
p.
171
croup,
p.
174
3.1
Bronchodilators
3.1.1 Adrenoceptor agonists
3.1.2 Antimuscarinic bronchodilators
3.1.3 Theophylline
3.1.4 Compound bronchodilator
preparations
3.1.5 Peak flow meters, inhaler devices and
nebulisers
Asthma
Drugs used in the management of asthma include beta
2
agonists (section 3.1.1),
antimuscarinic bronchodilators
(section 3.1.2),
theophylline (section 3.1.3),
corticoster-
oids (section 3.2), cromoglicate and nedocromil (section
3.3.1),
leukotriene receptor antagonists (section 3.3.2),
and,
in specialist centres,
omalizumab (section 3.4.2).
For
tables outlining the management
of
chronic and
acute asthma,
see p.
172 and p.
173.
For advice on the
management of medical emergencies in dental practice,
see p.
27.
Administration of drugs for asthma
Inhalation
This route delivers the drug directly to the
airways; the dose required is smaller than when given by
mouth and side-effects are reduced.
See also Inhaler
devices,
section 3.1.5.
Solutions for nebulisation
are available for use in severe
acute asthma. They are administered over 5–10 minutes
from a nebuliser,
usually driven by oxygen in hospital.
See also Nebulisers, section 3.1.5.
Oral
The oral
route is used when administration by
inhalation is not
possible.
Systemic side-effects occur
more frequently when a drug is given orally rather than
by inhalation. Drugs given by mouth for the treatment of
asthma include beta
2
agonists,
corticosteroids,
theo-
phylline,
and leukotriene receptor antagonists.
Parenteral
Drugs such as beta
2
agonists,
corticoster-
oids,
and aminophylline can be given by injection in
acute severe asthma when administration by nebulisa-
tion is inadequate or
inappropriate.
If
the patient
is
being treated in the community,
urgent
transfer
to
hospital should be arranged.
Pregnancy and breast-feeding
It is particularly important that asthma should be well
controlled during pregnancy;
when this
is
achieved
asthma has no important effects on pregnancy,
labour,
or on the fetus.
Drugs for asthma should preferably be
administered by inhalation to minimise exposure of the
fetus. Inhaled drugs, theophylline, and prednisolone (see
section 6.3.2) can be taken as normal during pregnancy
and breast-feeding.
Women planning to become preg-
nant
should be counselled about
the importance of
taking their
asthma medication regularly to maintain
good control.
Severe acute exacerbations
of
asthma can have an
adverse effect
on pregnancy and should be treated
170
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3
Respiratory system