Being nebuliser in A &E

[Snowdrop27]

When I had my asthma attack recently I went to A &E and was treated with a neubliser. The nurse who gave it to me was just going to set it up and leave me to it. I did stop here before she just set it up and asked a few questions. I never had this treatment before but have been aware of it through this forum.

She did give me a very brief reason why it was being done to open up the minute bronchioles in my lungs.The nurse did told me that you can have more of this and she seen people have much more treatment. (I think I must have looked a bit frighten) I added that I understood it was like the same as have 10 puffs of Ventolin. The drug used was salubamtol. I have Ventolin inhalers at home but had been given salubamtol inhaler last time I was in A&E.

The nurse they left me to it and I sat and just breathed it in. The salubamtol treatment lasted about 5-10 mins I think with a kind of mist. As I hadn't been told how long to where the mask I just sat there and waited for the machine to stop so 20 mins later. ( Before you criticize the nurse A &E was very very busy and this nurse I think had to pull of a ward to help)

When I saw the nurse again about 3 hours later she said I looked much better. I had presented with an asthma attack after no resolving after 10 puffs at home with main symptoms a cough but perfect peak flow and very good sats. (I can present like this and still be really struggling.)

What I would like to know is how the decision is made to nebuliser a patience? Last time I was in A&E my peak flow had drop 350/500 and I was wheezing for once. The doctor who treated me used 10 puffs of Ventolin and prednisolone wait 30 mins then repeated that 3 more times before he was happy and let me go. (peak flow back up to 400) So why didn't the doctor use the nebuliser?

Also what have been people experiences who have had been treated with a nebuliser? I am only interested in stories of minor use of this tool for treating asthma. Nearly all but one of my trips to A &E have been because I has an asthma attack go it under control or having one because it was a Friday night or the weekend so haven't been able to access my GP surgery.

Thank you for your advice and thoughts.

[EmmaF91 Community Ambassador]

Hi sorry to hear that you’ve not been too well recently.

Personally I’ve never been treated with my ventolin pump in a&e, I’ve always had at least 1 neb (probably because I usually go when my pump isn’t working and I have obvious symptoms), however at 70% the doc was probably seeing if you could improve from the vent by itself. It may also be a simple case of the neb machine already being used by someone worse off as there’s usually only 1-2 per department (assuming you were in minors), so seeing if you could respond on our own meds would have helped them, and stressed you less as the only other options would have been to make you wait (bad idea!) or to take you through to majors and connect you to a wall/o2 tank which would have happened if you didn’t respond or if you were worse on presentation. Nebs may also have been given to you this time because whilst it’s a more ‘severe’ type of treatment then just ventolin, it’s also easier for the staff if they’re busy... like you said you were set up and then left alone... and with asthma the approach tends to be better to over treat than under treat so they probably knew a neb would calm everything down without them having to be around as much as multiple trips to see you do ventolin.

Nebuliser wize there are many factors they’ll consider such as PF (if below 70%), o2 sats (so it may or may not be o2 driven) plus any recent exacerbation, how long the current symptoms have been there and what you’ve already tired to no effect. There are also different doses of salbutamol nebules (2.5-5.0mg) so depending on the severity they can up the dose easily. They can also add another drug (atrovent) to help too if you’re not responding. Most nebs will last about 15-20mins (tho obvs the more liquid in, the longer it takes).

Whilst it’s been a long time since 1 neb was enough to fix me I do remember my first (😂 that sounds like I reminisce over it like a first kiss), I remember starting to feel better about 1/2 way through it and being really teary/emotional whilst it was happening, and the shakes afterwards. I may or may not have had a headache after too 🤷‍♀️. Nowadays I tend to get shaky, headachy and tachycardic after 2 or more back to back and get tired and/or emotional afterward (tho this is when I’m on more than nebs usually so could be nebs or other drugs).

Hope this helps explain a bit the factors considered to decide if you need a neb or not. Hope you feeling better now

Emma x

[Snowdrop27 in reply to EmmaF91]

Hi EmmaF91 Thank you for the explanation of how neublisering is done and why it was very through.

You did make me smile when you said the memory of your first one was like your first kiss! ?

To fill you in a bit more detail of my visit I was in minors where I been before. I notice there was two neubliser there. Obviously I was the only asthmatic in that night because they stayed unused after I used one.

Thanks for explanation on the after effects of having been neublizered. I didn't feel emotional but had a cough which came every couple of minutes. I did look up the side effects after I got home. Didn't know this was what and didn't ask. I think part of this was I was a bit freaked out having it. Perhaps I did feel a bit emotional too difficult to tell when your stress a ready and trying to put on a brave face.

I definitely think it gave me a headache which made my head throb and continue for the rest of the day. I was taking salbumtol inhaler at home afterwards. I had had 14 lots of it before A &E and the equivalent of 10 by neubliser and 6 more twice 5 hours apart.

I think your right there is a tendency to over treat and they were very busy with all the beds full on the other side. I just didn't think they have the time to supervised me doing the 10 puffs like I did last time. What I can't work out is I didn't think I warranted it but we have to trust the doctors and nurses who treated us.

Lastly I was so busy concerating getting myself sorted and trying to look after hubbie who was sitting in an uncomfortable chair that I forgot the emotional fall out of going to A &E can have on me. This one hit me out of the blue and when I realised what had caused it. (Sweeping up mouldy hay) I was a bit cross with myself I sometimes hate the restrictions that asthma can put on my life. I have had a very bad winter with 3 asthma attacks in October/November. Two of them while even still on a course of prednisolone. Then one in January and one now.Plus having to go under consultant care did shake me a bit.

However I did get a very good consultant with a very good side manner. Just a week to go then I see him again and will be telling him what's been happening since we last met in November. (Test results for breathing test will be back then and blood test results) I hoping that I can go back to GP care soon after that. My asthma has no symptoms spring/summer.

I know this was a long post but I feel much better getting it off my chest.

[EmmaF91 Community Ambassador in reply to Snowdrop27]

Hi yes talking about it can have a calming effect esp when to people who have been there themselves and understand what you’re going through. Cough wise post neb I do also tend to get a sore/dry throat for a day or so after as well, mainly from where the drug ‘sticks’ to my throat on it’s way to my lungs... similarly I can get sores/spots around my mouth and nose from where it hits my skin.

The docs are usually better at judging what you need if you’re not ‘use’ to the more severe attacks, although after a while of these you learn what works best for you so it can become frustrating if they won’t give it to you (from the severe asthmatics POV).

I’m glad you’ve got a consultant that’s helpful and listens to you! Hopefully everything will calm down for you soon and you can go back to primary healthcare support xxx

[emmasue]

Emma explains very well. I have always had a neb for an asthma attack except once at A&E they tried me on the ventolin and sent me home. A GP can give a nebuliser too and I have had them at the GP's office before. I am not sure of the criteria but they do wok very well. Some people who have severe asthma have a nebuliser at home but so far I haven't needed that. I hope I don't get that bad!

I hope you feel better soon. Take care of yourself. x

[Wheezycat]

The only time I ended up in hospital (sent by my GP straight to AMU), I had back to back nebuliser, two at first, then one a time regularly for two or three days. I found the sensation of that damp, cool ‘air’ round my face very soothing, I can still remember it. Two nebs back to back left me feeling dizzy and a bit sick, but one was fine.

[hypercat54]

I had a bad flare up once and went to the doctors after leaving it for too long. My symptoms were that I was continually coughing and couldn't take a deep breath. The doctor put me straight on the nebuliser and I felt a lot better afterwards. x