How to know when to take reliever?

Hi Just a quick question really...

I'm in the middle of a bad asthma exacerbation (it's been going on since October) and am symptomatic pretty much all the time - coughing, short of breath, tight chest, can't hold a conversation for too long etc. I have never had a lengthy exacerbation before, and so am not really sure when to use my reliever...before this I just had a couple of quick puffs when having an acute attack, and didn't need it for anything else. Now, though, I'm really struggling throughout the day and just not sure when or if I need to use it. If I have a particularly bad coughing fit I will take a couple of puffs and things will settle down for a while, but the cough will return easily within an hour. I'm seeing a specialist for the first time on Monday but I'm just not really sure how to stay on top of symptoms when they occur so regularly! I should say I don't really like taking it if it's at all avoidable, it makes me very shaky (I take terbutaline because salbutamol always made my heart go into overdrive!)

Any advice/comments are greatly appreciated!

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Hi - thanks for the reply I am on fostair and take that twice a day. My reliever is a turbohaler which means I don't need a spacer for it, and at the minute I'm taking two puffs when my coughing gets too bad to draw a proper breath in afterwards - that tends to happen whenever I try and move around, so I'm spending most of my time sat in one place! It does tend to help with the coughing for about an hour but then it will return.

I am keeping a peak flow diary, but I can't find a pattern at all - the results vary from 420-510 regardless of how I'm feeling! I play a woodwind instrument so my peak flow has never been that accurate a measure. I don't have any pred at home - have only been on it three times in the past - and I'm kind of at a loss as to how to manage these everyday persistent symptoms. I will keep taking terbutaline though cos it does help relieve the symptoms, I just wish I didn't have to!

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I also struggle with this question - I think this is something that is worth discussing with your doctor because in my experience so far, different doctors have different opinions on this matter. Also it depends on how volatile your particular flavor of asthma is.

For example:

1) doctor #1 at urgent care: if you need reliever less than four hours after using ventolin, it's by definition a moderate or more acute exacerbation and so you at least need to be here for observation.

2) doctor who fills in when my regular doctor is not in: normally every four hours, but until we get this exacerbation under control up to every two hours. But more than that go in.

3) doctor #2 at urgent care (after seeing my doctor's letter to pulmonologist): oh, you can use it up to every twenty minutes, that's what we do here.

4) my doctor:

a) lecture on why should use whenever symptoms are significant and growing - do not wait until you can't tough it out any more.

b) initially: same four hour rule as doctor #1 at urgent care

c) later on when he finally was confident that I wasn't going to get rapidly worse: use reliever PRN; call in if using very frequently (2-3hrs over extended period) to discuss medication adjustment; use your judgement about whether to go in if you can't reach me.

So it can really vary depending on the situation.

Just bumped a post I started with some additional discussion about ventolin, peak flows/music issue, Ventolin and Mind Games

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I have qvar as a preventer and salamol and ventalin as relievers and have never had any side effects with any of them

I know some people get the shakes with theirs but i don`t know which they have

I hope you feel better soon

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I am in the middle of severe problems and am using 10 puffs an hour! But this is exceptional and under my drs guidance - I am doing the rounds of chemists though as my usual one got really funny when I had 2 prescriptions in a day for salbutamol, as well as my other asthma meds and 224 prednisolone tablts!!!