Author Archives: Jackie Aim

Preventers – tablets

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Medicine name How its taken Device Side effects
Montelukast(Singulair®) Preventer. Taken regularly every evening. Tablets, chewable tablets and granules. When your child first starts taking montelukast they may have the following side-effects. Most of these wear off as your child gets used to the medicine. If they are still a problem after about 2 weeks, contact your doctor.
They may feel or be sick (vomit) and have diarrhoea.
They may get headache or muscle pain (myalgia).
They may have a dry mouth or feel thirsty. Eating citrus fruits (e.g. oranges) and taking sips of water may help.
Your child’s skin may feel itchy. Using a moisturising cream may help.
Your child may have nightmares or problems sleeping.
Your child may feel tense, nervous or ‘on edge’. Young children (under 5 years of age) may seem more active than usual.
Your child may feel light headed or faint. They should try not to stand up too quickly. They should lie down for a while if they feel faint.
From medicines for children
Zafirlukast Only used for children over 12. Preventer. Taken regularly every morning and evening. Tablets The following side-effects should get better after a week. If they don’t, or you are worried, contact your doctor.
Your child may get stomach ache or stomach cramps or feel sick (nausea) or be sick (vomit). Giving the medicine with some food or milk may help.
Your child may get a headache (they may say their head is painful or pounding).
There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor.
From medicines for children


For advice on giving your child tablets please see Medicines for Children – Types of medicines.

Please note:

These are the most commonly used tablets at the time of publication of this website. If you do not see your tablets you can speak to your GP or pharmacist or check the patient information leaflet for your medication.

Combination inhalers

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Medicine name How its taken Device Side effects
Budesonide + Formoterol
(Symbicort®, Pulmicort®)
Taken regularly every morning and evening. Some older children also take 1 puff when required as well as taken regularly. Turbohaler® Your child may develop a yeast infection in the mouth, called oral thrush. If you notice a thick white or cream-coloured covering on your child’s tongue, or the mouth is red and irritated, contact your doctor for advice treatment. You can help prevent this by making sure that your child rinses their mouth after using steroid. Your child may develop a dry mouth with this medicine. Eating citrus fruits (e.g. oranges) or taking sips of water may help.Inhaled steroid may slow the speed at which your child grows at the start of treatment, but will probably catch up when their asthma is properly controlled. Their final adult height should not be affected. All steroid medicines, including beclometasone, budesonide, fluticasone but only in high doses, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery. From medicines for children.

These side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most children tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.

Fluticasone + Salmeterol(Seretide®) Preventer. Taken regularly every morning and evening. Evohaler®, Accuhaler® Your child may develop a yeast infection in the mouth, called oral thrush. If you notice a thick white or cream-coloured covering on your child’s tongue, or the mouth is red and irritated, contact your doctor for advice treatment. You can help prevent this by making sure that your child rinses their mouth after using steroid. Your child may develop a dry mouth with this medicine. Eating citrus fruits (e.g. oranges) or taking sips of water may help.Inhaled steroid may slow the speed at which your child grows at the start of treatment, but will probably catch up when their asthma is properly controlled. Their final adult height should not be affected. All steroid medicines, including beclometasone, budesonide, fluticasone but only in high doses, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery. From medicines for children.

These side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most children tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.

Fluticasone + Vilanterol (Relvar Ellipta®) Preventer. Taken regularly once a day. Only used for children over 12. Ellipta® Your child may develop a yeast infection in the mouth, called oral thrush. If you notice a thick white or cream-coloured covering on your child’s tongue, or the mouth is red and irritated, contact your doctor for advice treatment. You can help prevent this by making sure that your child rinses their mouth after using steroid. Your child may develop a dry mouth with this medicine. Eating citrus fruits (e.g. oranges) or taking sips of water may help.Inhaled steroid may slow the speed at which your child grows at the start of treatment, but will probably catch up when their asthma is properly controlled. Their final adult height should not be affected. All steroid medicines, including beclometasone, budesonide, fluticasone but only in high doses, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery. From medicines for children. Information on other side-effects can be found in the Patient Information Leaflet in the pack or on the electronic Medicines Compendium (eMC) website.

These side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most children tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.

Please note:

These are the most commonly used inhalers at the time of publication of this website. If you do not see your inhaler you can speak to your GP or pharmacist or check the patient information leaflet for your inhaler and medication.

Preventers – steroid inhalers

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Medicine name How its taken Device Side effects
5. Beclomethasone
(Asmabec®, Clenil Modultie®, Qvar® (only for over 12 years))
Preventer. Taken regularly every morning and evening. Metered dose inhaler, Clickhaler®, Autohaler®, Easi-Breathe®Insert pictures Your child may develop a yeast infection in the mouth, called oral thrush. If you notice a thick white or cream-coloured covering on your child’s tongue, or the mouth is red and irritated, contact your doctor for advice treatment. You can help prevent this by making sure that your child rinses their mouth after using steroid.Your child may develop a dry mouth with this medicine. Eating citrus fruits (e.g. oranges) or taking sips of water may help.
Inhaled steroid may slow the speed at which your child grows at the start of treatment, but will probably catch up when their asthma is properly controlled. Their final adult height should not be affected.
All steroid medicines, including beclometasone, budesonide, fluticasone but only in high doses, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery.
From medicines for children
These side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most children tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.
6. Budesonide(Budelin®, Pulmicort®) Preventer. Taken regularly every morning and evening. Easyhaler®, Turbohaler®
7. Fluticasone(Flixotide®) Preventer. Taken regularly every morning and evening. Evohaler®, Clickhaler®, Accuhaler®

Please note:

These are the most commonly used inhalers at the time of publication of this website. If you do not see your inhaler you can speak to your GP or pharmacist or check the patient information leaflet for your inhaler and medication.

Relievers – long acting

It is unlikely that your child would be given a long acting reliever inhaler for asthma alone, it is usually used in combination with a steroid inhaler. Sometimes they are given separately to test the response to the medicine and if this is successful, they would normally be prescribed together in a combination inhaler.

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Medicine name How its taken Device Side effects
Salmeterol
(Serevent®)
Long acting reliever. Usually taken every morning and night. Metered dose inhaler,
Diskhaler, Accuhaler
Your child may feel dizzy or light-headed when they stand up, they may feel sick, may get headaches, have a mild tremor (shakiness), especially in the hands, or have joint or muscle pain or cramps.
Some children may become more nervous or anxious than usual, and they may have disturbed sleep. From medicines for children
Formoterol
(Atimos®,Foradil®, Oxis®)
Long acting reliever. Usually taken every morning and night. Easyhaler, Turbohaler Your child may get shakiness (particularly in the hands), nervous tension, headache, fast or fluttering heartbeat, disturbed sleep, behaviour changes or muscle cramps. Also, nausea, dizziness, rash, taste disturbance and itch. From medicines for children

Please note:

These are the most commonly used inhalers at the time of publication of this website. If you do not see your inhaler you can speak to your GP or pharmacist or check the patient information leaflet for your inhaler and medication.

Relievers – short acting

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Medicine name How its taken Device Side effects
1. Salbutamol
(Ventolin®, Airomir®, Asmasal®, Pulvinal®, Salamol®, Salbulin®)
Reliever. Taken when asthma symptoms start Metered dose inhaler,
Clickhaler, Easyhaler, Easi-Breathe, Accuhaler
Your child may get shakiness (particularly in the hands), nervous tension, headache, fast or fluttering heartbeat, disturbed sleep, behaviour changes or muscle cramps. From medicines for children
These side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most children tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.
2. Terbutaline
(Bricanyl®)
Reliever. Taken when asthma symptoms start Turbohaler Your child may get shakiness (particularly in the hands), nervous tension, headache, fast or fluttering heartbeat, disturbed sleep, behaviour changes or muscle cramps. From medicines for children
These side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most children tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.

Please note:

These are the most commonly used inhalers at the time of publication of this website. If you do not see your inhaler you can speak to your GP or pharmacist or check the patient information leaflet for your inhaler and medication.

Other asthma medicines

Hospital paediatric medicine cupboard

2009


Long-acting relievers

  • These are usually in a 2 in 1 inhaler combined with your child’s inhaled steroid.
  • Normally taken every morning and night.
  • Green inhalers – these are used less often now and only contain a long acting reliever but no steroid.
  • If your child is on a green inhaler they should also have a preventer and reliever inhaler. Check with your asthma team.

Non steroid preventer tablets

  • Are available as tablets, chewable tablets and granules.
  • Usually taken as well as reliever and preventer inhalers.
  • Normally taken every day.

Oral steroids 

  • A short course 3-5 days is used to treat an asthma attack.
  • Your child must continue to take usual treatment while taking oral steroids.

Make sure you know what medicine your child should take and when. If you are not sure, ask your doctor, nurse or pharmacist. If your child can understand instructions about their medicine they should also  know what they are for and when to take them.

 

Why use a spacer?

Large volume spacer

Large volume spacer

  • It can be difficult for children to co-ordinate breathing and pressing their metered dose inhaler.
  • The spacer holds the dose of medicine so your child can take several normal breaths in and out to get all the medicine in to the lungs.
  • This normal breathing method using the spacer is just as effective  without the need to hold their breath and then breathe in quickly.
  • A spacer allows more medicine to reach the lung.

For more information on using inhalers with a spacer see ‘A practical guide to inhalers’.

Spacer devices are also used for ‘multi-dosing’. Multi-dosing means taking more than the usual two puffs via the spacer.This is a great way of getting medication to the lungs especially in asthma attacks – in actual fact this method is as effective as using a nebuliser. The inhaler should be fitted into the spacer after shaking, pressed once and inhaled normally over 5 – 10 breaths. These steps should then be repeated as directed, usually for between 5 and 10 doses of the inhaler, shaking before doses as usual. It is important though that each dose is inhaled separately – it won’t be as effective if more than one dose is fired from the inhaler rapidly after each other, they need to be given and taken individually.

Why use inhalers?

Blue inhaler

Metred dose inhaler

Purple accuhaler

Accuhaler®

Blue easibreathe

EasiBreathe®

Blue turbohaler

Turbohaler®

  • Asthma is usually treated with medicines given by inhaler.
  • Inhalers, if used correctly, deliver the medicine direct to the lungs.
  • There are many different types of inhaler device available – the images above are just a few of the many available.
  • Your child should be provided with an inhaler device which is appropriate for them and their inhaler technique should be regularly checked.
  • You should also know the correct method of using the inhaler so you can check if your child is managing the inhaler effectively.

 

 

Asthma medicines – relievers and preventers

There are 2 basic asthma medicines:

Reliever Preventer
Blue inhaler Brown inhaler
Relievers:

  • Are usually blue inhalers.
  • Everyone with asthma should have one.
  • Should be taken when asthma symptoms start.
  • Should relieve asthma symptoms for a few (approx. 4-6) hours.
Preventers:

  • Are usually brown or orange inhalers.
  • Are inhaled steroids.
  • Steroids help reduce inflammation in the lungs.
  • Preventers reduce the risk of severe attacks.
  • Need to be taken every morning and night (usually) even when feeling well.
  • Don’t have an immediate effect it may take up to 14 days before you notice any improvement in your child’s asthma symptoms.
  • You should not stop your child’s preventer inhaler without medical advice even if they are feeling well. This shows the preventers are working.

Self management

4 weeks later

Sarah and chloe talking to the practice nurse

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  • Nurse says “Well, how’s Chloe?”
    Nurse thinks “They both look great!”
  • Mum says “A new girl! Thank you so much for your advice. She fought me for about 7 days but I just wrapped her up like you said. She stopped fighting and sits to take her inhalers like a wee star now. And her cough has gone. She sleeps all night and even had a cold last week which didn’t really come to much!!”