Neb Guidance

Hi all. Hope evryone's well.

Just a quick question. We got Holly's nebuliser a while back from cons so we could neb budesonide and salbutamol. I'm obviously very clear on the budesonide in that its twice a day but I was never given clear guidance on the salbutamol.

Up to now I've been using my common sense and if she's not able to take her inhaler through her spacer I've been giving her the salbutamol through the neb instaed. She's got a cold just now though and her neb use is much higher. I've been using 4 or 5 in 24 hours. Phoned cons this morning but couldn't get him. Phoned doctors instea and they said just use as and when required.

Do I just treat the neb like I would use the 10 puffs and start to worry if they don't last the full four hours or am I using too much just now.

Any advice greatly appreciated.

P.s Holly's 6 and been diagnosed for a few years now although rarely has good control.

Decided to edit this as on readin it back it looked as though I was looking for immediate advice. I'm actually just querying what others who have home nebs have been advised. Obviously I know the protocol if the inhaler andnebs aren't working or in the event of an attack.

Thought I should clear that up

Anne

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Hi

I am sorry I can't be of much help here, but I have nebs at home....I have salbutamol nebs 4 times a day and can increase upto 6 if I need to like if for example I have a cold etc....But this is something that has been discussed with my cons, GP's and practice/asthma nurses on many occasions and have it in my action plan....But I am an adult and also brittle so would not really know for a child, sorry....If in doubt ring the GP again if you can't get the cons.

Sorry

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Hi Anne, you probably already realise this, but you really need to speak to your daughter's consultant about this, 4-5 nebs even for an adult seems a fair bit. I use my nebuliser usually every 4 hours (i.e. 6 per day) using inhaler inbetween for milder symptoms or having another neb,my consultant instructed me to have 4-6 hourly plus as needed when I'm having an attack I can have some back to back nebs then if no improvement I should go to hospital. But your daughter is quite young, and home nebs should be given with clear instructions, has your consultant given you a written protocol? If not when you speak to him/her next time please ask for one stating exactly at what frequency and dose each treatment should be given at. Sorry I couldnt be much help but home nebs (as with other treatment) is different for everyone.

Hope you get answers soon, simi x

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If you really press the GPs they should give you some more guidance. I was given a nebuliser at home by my GP before my cons later approved it (*hides before she gets pelted!*). But I was using ridiculous amounts of ventolin anyway and was having problems with not being able to use a spacer properly as I was coughing too much. In case anyone wonders after a week of relative success saw my consultant and he was perfectly happy with it as it had been discussed before and I had said no.

Back to the point .... initially I was given strict guidelines by my GP that it was only being done to enable me to complete the year at uni and that i was only to neb 6 hourly and to consult her/cons/AnE if I deteriorated at all. These guidelines were only written down for me by my GP when I asked and have later been adapted by my consultant from time to time.

I think that it might be a wise idea to phone the GP and say that you are not particularly happy using it without guidance/protocol and ask for one to be written specifically for Holly. Or to get hold of the consultant to ask for some if possible. I think it is easier to make a decision to go in to hospital or AnE if you know that someone else is supporting your decision.

I hope that my ramble has helped in some vague way.

Em

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Thanks for your replies everyone.

Couldn't get a hold of cons again this morning so again phoned doctors. I spoke to the asthma nurse who advised to use them as I would the ten puffs. I asked if I could speak to a doctor to clarify this and the Gp suggested the same as the asthma nurse but couldn't give further details. He also suggested upping her pred. I said I'm not really happy to do that without confirmation from cons first. I know this sounds twisted but she's already on 40mg of pred a day and along with her other meds, I find this quite substantial.

Long and short of it is until I get a hold of cons, nobody's prepared to be accountable for the number of nebs I give her. I'm now continuing to give them as I would the ten puffs and as soon as she's unable to go four hours, I'll take her to A & E.

Tanks everyone

Anne

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Anne, what a horrible situation you are in. I think you will just have use your common sense until you are able to get a sensible plan, you sound like you know when it too much or if you need more medical help. One small thing unless there is a problem absorbing steriods (pred) there is no indication that upping it beyond 40mg makes any difference, so not upping the pred makes sense.

Good luck

Bex

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Thanks for the reassurance about the pred thing Bex. I'm usually really quite confident about all of this but every now and then I get a little wary or disconcerted.

I'm going to try again to get the cons on Monday and if I can't get him I'll just ask to speak to another cons. It wasn't until reading others posts on other subjects that I realised how strict other peoples protocols are and I've just realised how limited the guidance I have is.

Thankyou everyone

Anne

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