Salamol doses how many hours minimum ?

[Kristinema]

My son is 4 and a half. Since March this year he has had 3-4 wheezy episodes that required AE attendence. He was all times given a reliever inhaler. He has not been diagnosed with asthma yet, but seems so much the case to me. He had eczema as a baby and many allergies. He grew out of the eczema and most allergies but remains allergic to tree nuts. He had a wheeze episode 2 weeks ago. AE gave us salamol inhaler and sent us home with it after 4 hr of monitoring. They told us to give him 10 puffs every 4 hours for the first night and then start weaning him off it. Today 2 weeks forward he seems to feel the same. Coughing fit , heavy breathing. Gave him 10 puffss. Only relieved a little bit . How soon can I give the next 10 puffs. Is it 4 hours the standard. Im gonna request a preventer not sure on what basis they can prescribe it but we not managing this well with relievers . It keeps coming back. Does this sound like Asthma.

[Chip_y2kuk]

Poor baby boy, Salbutamol should last a maximum of 4 hours... I have had spells of it not lasting 45 mins and got a stern telling off when I finally did get seen (I was in a bad way at that point) ... and I'm an adult

So salamol (salbutamol) should last 4 hours and if its not he probably needs to be seen again as a matter of urgency

Also 10 puffs is a lot of salbutamol so if that's not helping I would be more inclined to seek *urgent* medical help

Also does the inhaler have any left in it... they are 200 puffs so if you've been giving him 10 puffs every 4 hours that's ~60 puffs a day give or take a few .... thats not going to last too long

[Kristinema in reply to Chip_y2kuk]

Thank you for reply. I followed the same routine the docs did on the first two cases they gave us it. So they started at 10 puffs. ( even though it says two puffs when needed in the box) It does seem that indeed our inhaler might have run out of medication hence it did not last or help for long. Brought out the prescribed new one from gp which is called ventolin. Gave it 4 hours after the first ones. 5 mins after my son threw up his dinner. Could it be a side effect? He seems calmer but the cough has not gone away. No more wheeze though. He can barely speak cause of the cough . We are likely making our way to AE again. Im not sure if they consider the cough as seriously as the wheeze. My son said also his chest and belly hurts which might be the chest tightness .

[Sjb10 in reply to Kristinema]

Hi. Poor thing ☹️ If you haven’t already I think you need to head back to A&E. my son at around 4 years old (a long time ago now!) had v similar issues and the stomach hurting was actually his chest but he couldn’t articulate it. He was then diagnosed with asthma and given a preventer. As already said the blue inhaler should be lasting 4 hours and if not he needs to be seen urgently. Hope he feels better v soon (and you! It’s v stressful for parents!)

[peege]

5 hours ventolin should last. I just don't understand why people are not told to wait 30 seconds between each puff of an mdi *(metered dose inhaler/spray type). Each inhaler contains a propellant, we have to wait 30secs for the medication to drop down through it, still shaking between puffs. Hopefully perhaps if you try this you'll get better results. What I dont know is if the one puff remains in the spacer until you do a second puff or leaks out. My son at 3 had to learn how to inhale directly from the inhaler as there weren't spacers or the nice little silicone masks then. He was very good as I know now it's hard enough to learn the technique as an adult.

I really feel for you as a mother of an asthmatic son (now grown up). We were living in N Africa where he was born. At two+ he caught a cold which quickly turned into bacterial bronchitis on a visit home to England, damp September nights he just didn't get better even after getting back to the warm dry climate. Eventually found a British doctor who diagnosed asthma straight away, prescribed brown preventer and blue ventolin.

Nowadays medics are reluctant to diagnose asthma in small children under 5/6. I know this due to baby g'daughter sufferings & GPs in West London refused to diagnose asthma even though a&e visits sent her home with ventolin. I could tell it was asthma from the off. She's 10 now & copes well with inhalers (though having ventolin hidden in sports bag due to school rules of medication being locked away, sometimes in locked classroom grrr). Luckily on moving to Buckinghamshire, new practice GPs still refused to diagnose asthma until they saw a European GP in the practice who poo pood the 'British system re asthma ' & prescribed inhalers immediately & we've not looked back (as long as my daughter remembers to reorder prescription before it runs out)!

Hope things work out for you and your dear son, if I were you I'd call the AsthmaUK helpline for guidance on getting the best out of NHS GPs (if it doesn't work can you get private diagnosis?). P

[peege in reply to peege]

PS I recall coughing incessantly as a child, the coughing is so deep I often vomited. My son did too. I recall asking the obstetrician at near full term "can you get a cough in the stomach?" I'd coughed so much I was coughing up blood. I had no idea I had asthma until I walked into a GP appointment in 2007 coughing my boots up, she turned to a trainee nurse who was sitting in to learn & said "that cough is a typical asthma cough, never forget it".

In asthma our trigger makes us cough which in turn inflames the airways which makes us cough more which closes the airways even more. Unfortunately one of the risks is that any mucus in the lungs can't get out therefore leaving a perfect environment for bacteria to grow leading toan infection. (Sorry to rabbit on, I cant bear that children aren't treated properly). ××

[Kristinema]

Thank you all for all the info. And I do believe its a shame the nhs makes it so difficult to diagnose kids when this could avoid all the flare ups. I did feel that we could control it better if we had a plan and preventer. I was yet again told today by our Gp that they cant diagnose him at this stage but I managed go get finally a referral to respiratory clinic in Chelsea and Westminster hospital, I hope it doesnt take long to be seen if it does might try private route again.The cough seems to me like an asthma cough as well as it seems he is trying to clear his airways and coughs even more . I will try waiting 30 seconds between puffs. What we doing at the moment is I give him two puffs back to back 10 seconds counting each. Then shake the ventolin for 30 seconds and then give two more. So 2 at a time. I might just have to wait between each one. He seems better today. No wheeze and the cough has eased to just once in a while. It has been triggered by cold air or viral. Does steam in shower help with Asthma flare ups?

[Lysistrata Administrator Community Ambassador in reply to Kristinema]

Hi, you've had lots of other advice which I agree with from my non-expert point of view - especially re seeking help.

Re steam - I'd be careful with that. It has this reputation as being great for all respiratory problems, and some people with asthma can find it helps - but it can also be a trigger! I don't do well in warm humid environments. Not all doctors seem to be aware of this either so be cautious if you're advised to (I was told to once by a GP who wouldn't listen when I said it made my asthma worse and so did Vicks).

I agree with Peege that you may find it useful to chat to the nurses on the Asthma UK helpline: 0300 2225800 M-F 9-5; WhatsApp - 07378 606728. They're experienced nurses and have a bit more time to chat than a GP usually does.

Hope your son feels better soon and you can get some help for him including a plan.

[Ken6]

Dear Kristinema, I am very sorry to hear of your problems. I have read most but not all the replies below. I have adult onset asthma so my experience will be different to you. I have used a dozen or more Salbutomol and Ventolin over the last few years. I do not think there is any difference between them. It is quite important for your son to hold his breath for ten seconds after taking each puff. I realize how difficult it may be for you and your son to do this during an asthma episode. Perhaps this is the reason you have been asked to administer 10 puffs. When I first developed asthma 2 puffs of Salbutomol were absolutely brilliant at stopping the asthma episode. It does sound like asthma. I would go back to your doctor.

Best wishes Kennneth

[Lysistrata Administrator Community Ambassador in reply to Ken6]

Hi Kenneth, just to jump in for Kristenema (if she's not aware) and anyone else reading this who isn't aware - if you use a spacer (recommended for children and adults), you don't necessarily have to breath hold afterwards. This page has a general overview of spacers and also two links to different options for spacer use. One is the breath hold technique, and one is for tidal breathing (so you put in a puff to the chamber and breath in and out a few times). I've generally been told to use what works for me, so either is fine (I'd imagine a small child may find it easier not to have to hold). asthma.org.uk/advice/inhale...

The 10 puffs, ideally through a spacer, is standard advice for an attack, 2 puffs standard for asthma symptoms day to day and should work most of the time. I definitely find it easier to use the spacer with the tidal breathing in an attack, so I don't have to think about what I'm doing too much!

[Kristinema]

Thank you. Yes we use a spacer and he is instructed to breathe in and out in the spacer . So I press the spray and he inhales and exhales inside the spacer for 10 seconds, then I press the next. He seems better today. Now looking forward to the respiratory clinic getting in touch and booking an appointment . I hope we get a plan soon and are able to avoid these very worrying episodes. I am planning to contact the Asthma nurses via whatsapp indeed.

[Ken6 in reply to Kristinema]

Dear Kristinema, Yes using a spacer is fine. Being an oldie I did not think of that. I hope my other comments are more helpful.

ken6

[Spikedog66]

Hi 10 puffs of ventolin are equivalent to a nebuliser if you are using this frequently as you have indicated you must seek medical advice. A child can get into severe difficulties. Please dont wait. Ring an ambulance. As a retired paediatric nurse we told parents only use 10 puffs as an emergency measure adults cope a little better with this regime. I agree a preventer is probably required. Seek help your childs asthma seems very brittle at present. Good luck.

[Kristinema]

Hi everyone. Hope everyone is keeping well. Not sure if you remember this last post of mine. We did get a respiratory clinic app but for March. He did got better after the new ventolin was used ( turns out the first one had run out of medicine) and he was well for about two months and then when school started again he managed to get another horrible cold that triggered sth that started exactly the same, severe constant cough for a day, followed by a day that he doesn't cough but starts breathing heavy. I started on two puffs, then 4 puffs and none worked and I knew that by the time he needed 10 puffs was time for a trip to AE again. They kept us in for hours. Gave him 10 puffs every two hours, then a steroid inhaler, and then we were kept in the ward overnight. Finally sent home with a Brown inhaler for a 6 week trial. Does the Brown inhaler cause any side effects? Does it make the symptoms worse when you just start it until it kicks in? We were given prednisolone liquid also for 2 days for him to take. All of this happened while waiting to be seen by the respiratory clinic in March.