Nebulisers v inhalers

I've been told by RBH that 10 puffs ventolin via spacer is just as good as a neb. On thursday Sean was really struggling with a cold cough etc so i started two hourly puffers in the day and nebs at night as he sleeps through nebs. After discussion with resp nurse on fri i was asked to get him checked out at local hosp. He wasadmitted and same treatment continued. While there I was told by two docs that as he 'only 'needing inhalers he could go home, but it would be differnt if he needed nebs. Well to be honest I am so sick of hospitals at moment that I couldnt be bothered to argue so we came home on sat and i've been doing 2 hrly ever since as he not maintaining sats at night.

SO my question is: How can it be right to have 2 hrly vent inhaler for five days at home but not 2 hourly neb as that means u r iller?

If anyone could enlighten me i'd be grateful

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Julie- if he's still not right take him back to the hospital. You'll get ill/insane through sleep deprivation otherwise and you need to be well to look after him never mind the effect it's having on him too.

I've had kind of similar recently, had very wierd treatment on my last admission which i was going to post about to see if anyone knew if there'd been any recent articles/guidelines out which might explain it. After 48hours in hospital when i was more stable i was moved from nebs to 10 puffs of combivent 4 hourly with top up 2.5mg ventolin nebs and atrovent as required in between and regular saline to keep gunk moving. I needed both as was dipping between doses.

I was discharged with instructions to continue the combivent 4hourly at home but the gp said this was nonsense and put me back on regular ventolin nebs (6hrly) to let me get more sleep at night with atrovent only as required.

I know that 10 puffs of ventolin via a spacer is meant to be as good as a neb and a lot of the nebbed stuff escapes into the air but how can the dosage of a 5mg ventolin neb and an atrovent neb equate to 10 puffs of combivent?

Sorry not much help!

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I know for a long time the spacer versus the neb has been muted around in a+e dept and various chest depts. Personally I find the damp mist of the neb far easier to tolerate than the spacer and inhaler.

I keep trying to wonder why the idea has come about especially as they stopped manufacturing the vloumatic recently, then reintroduced it, mmmmm?

Being synical I wonder if it has anything to do with long term costs of nebs and servicing etc because other than that I cant see why the turn around other than its the ""in thing"" for now and all will change again eventually.

Not a lot of help to you though Julie, I hope Sean gets on ok at the appt and that you get some answers . You must be so exhausted. Hope they can sort thigns out for you both

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Another frequently debated chestnut!

Yes, I think we all know the basic equation:

10 puffs in a spacer = a 2.5mg neb

20 puffs in a spacer = a 5mg neb

I am really surprised that anybody in any A&E has actually tried to advise or prescribe puffs in spacers over much needed nebs. I am even more surprised RBH were suggesting it and even even more gobsmacked that a hospital were treating a severe asthmatic patient that way with just the odd neb to 'top up'

We all know how terrifyingly hard it is to get any medicine down into our lungs when we have gone off big time. At least with a neb the force of the mist is blown full frontal at us, regardless of how much escapes sideways : hopefully some does get in. Trying to suck anything out of a spacer whilst virtually gasping ones last is a total nightmare.

I have of course done the 10 puffs bit many a time-quicker than setting up any neb for a prophylactic dose, but there is no way I could inhale its contents when my lungs are stuffed mid-attack.

The theory is sound, the practicality of it, is negligable.

Sorry I am sounding so terribly opinionated here, but really, in reality, which one is the greater life saving device.

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Can i just add as a side track that i wasn't admitted to my usual hospital under my usual consultant but was blue lighted elsewhere, wasn't put on IV theophylline but was given adrenaline and more hydrocortisone on top of 90mg pred, was given 7 ish lost count back to back nebs in A+E not magnesium despite finding out later blood gases were off was monitored for 2 days in assessment unit needed humidified oxygen which had to be borrowed from ITU as that's the only place that has the stuff (what!!) this style of treatment has never happened before to me and i know they have a new super duper hotshot respiratory consultant in charge but unless i'm unconcious i will not be going back there will push to go to usual costa who still like nebs and use a standard treatment plan

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nebs v spacer

Hi Julie, hope Sean is doing OK at the mo. My son is 10 and we had a really strange visit to A&E last month. We use our local hospital all the time and are pretty well known there. jay has had 19 attendances in the last 9 months and been admitted 5 times this year. I had been really happy with the way he was dealth with right up until a month ago when hospital procedure changed and I was informed that unless Sats were less than 92% you should be treated with 10 puffs through a spacer. jay had a PF of 90 (best 350) couldn't talk and was tugging, but because his Sats were 94% the doctor gave him a spacer!!! jay thought he was joking. I had been treating him like this every 2 hours for the past 24 but he just kept dropping back down really quickly. After treatment his Sats dropped to 92% and his PF picked up to 140, but because he wasn't wheezing we were told to go. I kicked up a fuss, explained how often we were there (only to be told this must be because I am not giving him his medication properly - Argh)and asked what more did I want him to do. He was no longer ill so please go away! I asked to be refered to a paeds doctor and was told to go see my GP.

I continued giving 10 puffs on Ventolin throught the day and by 11.00pm had had enough. Went back to Hossie and saw really cute paeds doctor who said ""Oh yes, Sats over 92% treat with a spacer"" without even looking at him. Luckily a nurse who had treated us on many other occasions made a really big fuss and after a small fight won and was allowed to give Nebs (Salbutamol and Atrovent) by the end of the night Jay was admitted to HDU with low Sats and <33% PF.

So, after my really long story, I would have to say that I don't agree with spacers being as effective as nebs.