Child Health/Paediatric asthma / croup

Paediatric airway drugs

also: salbutamol · inhaled steroid · montelukast · dexamethasone croup · adrenaline nebuliser

Overview

Asthma and croup drugs as used in children — broadly the same agents as adults but with age-specific delivery (spacer ± mask) and the specific croup/bronchiolitis rules.

Mechanism

Salbutamol (β₂-agonist) → bronchial smooth-muscle relaxation. Inhaled corticosteroids → anti-inflammatory preventer. Montelukast (leukotriene receptor antagonist) → add-on. In croup, a single dose of oral dexamethasone reduces airway oedema; nebulised adrenaline gives temporary relief in severe croup.

Indications

Childhood asthma (acute + preventer)
Viral croup (oral dexamethasone)
Bronchiolitis (largely supportive)

The agents

SalbutamolSABA

spacer ± mask; nebulised if acute

Spacer is as effective as a nebuliser in non-life-threatening attacks.

Inhaled corticosteroid (e.g. beclometasone)preventer

Regular preventer; growth monitoring (height).

MontelukastLTRA

oral

Add-on; neuropsychiatric effects (counsel).

Dexamethasone (oral) / nebulised adrenalinecroup

Single-dose dex 0.15 mg/kg for croup; adrenaline neb for severe.

Adverse effects

Salbutamol: tremor, tachycardia, hypokalaemia (high dose)common

Inhaled steroid: oral candidiasis, growth velocity reductioncommon

Rinse mouth; monitor height.

Montelukast: sleep disturbance, mood/behaviour changeserious

MHRA neuropsychiatric warning.

Cautions & contraindications

Routine antibiotics/steroids in bronchiolitispaediatric

Bronchiolitis is supportive — they don't help.

Interactions

Monitoring & kinetics

Inhaler technique + adherence; height/weight on regular ICS; asthma control

Inhaled via age-appropriate spacer (± face mask under ~3 y).

Source: BNF for Children — Asthma · NICE NG9 — Bronchiolitis