.idiopathic pulmonary hypertension;
.sickle-cell disease with persistent nocturnal hypoxia;
.interstitial lung disease and obliterative bronchiolitis;
.cysticfibrosis;
.obstructive sleep apnoea syndrome;
.neuromuscular or skeletal disease requiring non-invasive
ventilation;
.pulmonary malignancy or other terminal disease with
disabling dyspnoea.
Increased respiratory depression is seldom a problem in
children with stable respiratory failure treated with low
concentrations of oxygen although it may occur during
exacerbations; children and their carers should be warned to
call for medical help if drowsiness or confusion occurs.Short-burst oxygen therapy
Oxygen is occasionally prescribed for short-burst
(intermittent) use for episodes of breathlessness.Ambulatory oxygen therapy
Ambulatory oxygen is prescribed for children on long-term
oxygen therapy who need to be away from home on a regular
basis.Oxygen therapy equipment
Under the NHS oxygen may be supplied asoxygen
cylinders. Oxygenflow can be adjusted as the cylinders are
equipped with an oxygenflow meter. Oxygen delivered from
a cylinder should be passed through a humidifier if used for
long periods.
Oxygen concentratorsare more economical for children
who require oxygen for long periods, and in England and
Wales can be ordered on the NHS on a regional tendering
basis. A concentrator is recommended for a child who
requires oxygen for more than 8 hours a day (or 21 cylinders
per month). Exceptionally, if a higher concentration of
oxygen is required the output of 2 oxygen concentrators can
be combined using a‘Y’connection.
A nasal cannula is usually preferred to a face mask for
long-term oxygen therapy from an oxygen concentrator.
Nasal cannulas can, however, cause dermatitis and mucosal
drying in sensitive individuals.
Giving oxygen by nasal cannula allows the child to talk,
eat, and drink, but the concentration of oxygen is not
controlled and the method may not be appropriate for acute
respiratory failure. When oxygen is given through a nasal
cannula at a rate of 1 – 2 litres/minute the inspiratory oxygen
concentration is usually low, but it varies with ventilation
and can be high if the patient is underventilating.Arrangements for supplying oxygen
The following oxygen services may be ordered in England
and Wales:
.emergency oxygen;
.short-burst (intermittent) oxygen therapy;
.long-term oxygen therapy;
.ambulatory oxygen.
The type of oxygen service (or combination of services)
should be ordered on a Home Oxygen Order Form (HOOF);
the amount of oxygen required (hours per day) andflow rate
should be specified. The clinician will determine the
appropriate equipment to be provided. Special needs or
preferences should be specified on the HOOF.
The clinician should obtain the consent of the child or
carers to pass on the child’s details to the supplier, thefire
brigade, and other relevant organisations. The supplier will
contact the child or carer to make arrangements for delivery,
installation, and maintenance of the equipment. The
supplier will also train the child or carer to use the
equipment.
The clinician should send the HOOF to the supplier who
will continue to provide the service until a revised HOOF isreceived, or until notified that the child no longer requires
the home oxygen service.
HOOF and further instructions are available at
http://www.bprs.co.uk/oxygen.html.
.East of England, North East: BOC Medical: Tel:0800 136
603 Fax:0800 169 9989
.South West: Air Liquide: Tel:0808 202 2229Fax:0191 497
4340
.London East, Midlands, North West: Air Liquide: Tel: 0500
823 773Fax:0800 781 4610
.Yorkshire and Humberside, West Midlands, Wales: Air
Products: Tel:0800 373 580Fax:0800 214 709
.South East Coast, South Central: Dolby Vivisol: Tel: 08443
814 402Fax:0800 781 4610
InScotlandrefer the child for assessment by a paediatric
respiratory consultant. If the need for a concentrator is
confirmed the consultant will arrange for the provision of a
concentrator through the Common Services Agency.
Prescribers should complete a Scottish Home Oxygen Order
Form (SHOOF) and email it to Health Facilities Scotland.
Health Facilities Scotland will then liaise with their
contractor to arrange the supply of oxygen. Further
information can be obtained atwww.dolbyvivisol.com/our-
services/healthcare-professionals/home-oxygen-services
-(sco).aspx.
InNorthern Irelandoxygen concentrators and cylinders
should be prescribed on form HS 21 ; oxygen concentrators
are supplied by a local contractor. Prescriptions for oxygen
cylinders and accessories can be dispensed by pharmacists
contracted to provide domiciliary oxygen services.Croup
Management
Mild croup is largely self-limiting, but treatment with a
single dose of a corticosteroid (e.g. dexamethasone p. 439 )
by mouth may be of benefit.
More severe croup (or mild croup that might cause
complications) calls for hospital admission; a single dose of a
corticosteroid (e.g. dexamethasone or prednisolone p. 442 by
mouth) should be administered before transfer to hospital.
In hospital, dexamethasone (by mouth or by injection) or
budesonide (by nebulisation) p. 160 will often reduce
symptoms; the dose may need to be repeated after 12 hours
if necessary.
For severe croup not effectively controlled with
corticosteroid treatment, nebulised adrenaline/epinephrine
solution 1 in 1000 ( 1 mg/mL) p. 136 should be given with
close clinical monitoring; the effects of nebulised
adrenaline/epinephrine last 2 – 3 hours and the child needs to
be monitored carefully for recurrence of the obstruction.ANTIMUSCARINICS
Antimuscarinics (inhaled) f
09-Feb-2016
lCAUTIONSBladder outflow obstruction.paradoxical
bronchospasm.prostatic hyperplasia.susceptibility to
angle-closure glaucoma
lSIDE-EFFECTS
▶Common or very commonArrhythmias.cough.dizziness.
dry mouth.epistaxis.headache.nausea
▶UncommonConstipation.dysphonia.glaucoma.
palpitations.skin reactions.stomatitis.urinary disorders.
vision blurred152 Airways disease, obstructive BNFC 2018 – 2019
Respiratory system3