high dose ventolin

[bluecar15]

Hi all!I was just wondering if anyone has come across this previously.

I finally went to my asthma nurse and she thinks that my asthma is even less controlled than I suspected

I know this is bad and I need to take it when needed but when I'm in need of my ventolin, if I don't get it, the need rarely gets that bad. It's uncomfortable yes but generally if I sit down and rest while controlling my breathing, it won't keep getting worse and my breathing will be controlled just shallower and my chest will feel uncomfortable. I do take my inhalers out and keep one anywhere I am regularly (so one at work ect) but honestly, I've got 2 linked neurodevelopmental disorders that affect my memory and my executive function and it often doesn't occur to me to take it, even while I'm feeling uncomfortable, until I'm coughing constantly or can't talk and it's really really obvious. My asthma nurse is aware of this as it obviously impacts on my asthma quite a bit, especially as until I made an appointment on the asthma UK nurses advise (thank you so much!!!) They had no idea how uncontrolled my asthma was as the frequency of my prescriptions does nothing to indicate how often my asthma is flaring. I am working on trying to take it as much as I can though it's not going fantasticallyif I'm honest as if I'm not thinking about it, I'm not thinking about it. I exhausted all the usual tips years ago with a previous asthma nurse, trying to add notes and reminders and the sort but as its not a conscious 'forgetting' but more of a unconscious it doesn't even occur to me I have asthma and that's why I've been out of breath all day and my chest hurts until the continous coughing reminds me. The nurse doesn't really have any tips that I'm not already doing other than asking me to try as hard as I possibly can to take it so that's what I've been doing. I probably take it at the 'shortness of breath and uncomfortable chest' stage maybe 1/20 times?? Possibly less. I'm far more likely to sit down and do controlled breathing (I've got other conditions causing severe pain/low blood pressure/tachycardia and this works for flares of all of them, I'm not doing it consciously but it's just automatic to do it if I'm feeling uncomfortable in some way without thinking. It's not just the asthma, I don't think to take any rescue medication and hardly ever thinkremember to take my as needed pain meds).

if where the nurse is comcerned,if i do register that the discomfort is my asthma and I need to just take my inhaler, even if I take it when the symptoms have just started (say I was doing something I knew was likely to set off my asthma and had remembered to have my inhaler in my hand ready)I need way more than 2 puffs. I use a spacer, I shake it, it's in date, I leave a minute between each puff but I need to keep taking it for a few minutes until my breathing returns to normal. If I stop at 2, it'll be a bit improved but not enough for it to have been worth taking the inhaler you know?I may as well have just sat down and controlled my breathing. The nurse wants me to call 999 if I've needed 10 puffs but that isn't a abnormal amount for me to need to get rid of some mild chest tightness, it doesn't get worse or come back, it's controlled but I know I'm not ill enough to be in hospital as frankly, I get mild symptoms daily due to my lack of asthma control and i know that had I not taken the inhaler at all I would have just waited and it would have stayed at the same level before eventually going away. I 100% understand the need for caution and I get why she wants me to call 999 in case but it honestly just seems like I personally need a bit of a higher dose of ventolin and if I had that it would work as expected and the only concern would be my compliance with the inhalers and actually taking them.

i asked her if I can have a standard higher dose on my plan or if there's an alternative rescue medication and she said it's the only option other than a dry powder one which probably won't work as a rescue medication for me personally as my key symptom during flares tends to be shallow breathing, so it'll be hard for me to get the medication that way. Now had she told me that therewhere other options but that we should concentrate on my compliance with my meds then fair enough, I would have understood. Thereisn't a lot I can do that im not already doing but I get not changing meds before you are even taking it correctly especially as I've been on ventolin for over 2 decades starting when I was a baby so clearly a lot of nurses and drs have thought it's a good choice for me but that's not what she's saying she's saying there's only 1 other rescue med and that's not appropriate. This part is just confusing me and I've been thinking it over and over. Is that really the case? How are there only 2 rescue medications for a conditionso rare? I know there are different brands but active ingredients wise there are only 2? And that's the case after only one medication being withdrawn? (intal) I really don't understand. She's saying that of all the people with asthma these 2 work fine as long as the asthma is controlled but for any other condition this common there are 10s of options. And they are all used because different medication works on different people. So how does the salbutamol in ventolin work for almost every asthma patient with the rest covered by the dry powder rescue one? Is it just that it doesn't but they haven't been able to develop any more so there aren't any options? Why can't I have a higher base dose of ventolin like you would with any other medication? How can there only be 2 dose options with the massivespectrum of severity in asthma?

I think the reason I'm needing more of the ventolin than usual is that I feel my symptoms low in my airways so the first few puffs are just opening the higher bits up enough so that the the 5th or sixth puffs get to where they need to be. As a child I'd use a big spacer with a mask and just breath in and out in the spacer with a puff of ventolin being added every minute or so till I felt better and so that's what I do when I'm ill and its affectingmy asthma. I assumed this was what the drs had told us to do and I'd just kept doing it but i had a search and most people do not seem to use their rescue inhalers like that at all! Theytake one puff and they are fine. There's no extended breathing in and out. I can't take a big inhale if my asthma is bad because of a chest infection or something as I need to take it slowly to get it in and further down my airways or I'd just cough it straight out. A few people seem to be using their Diffuser like this but they are saying they are using 'the volumatic as a nebuliser' so that got me wondering why they aren't just giving them a nebuliser to use and also what is put in a nebuliser, I think one is just ventolin but are there others? If so, can't I get one of those in an inhaler?

thank you!

[bluecar15]

Sorry for the incredibly long post, I just want to understand. I fully get the importance of getting my asthma as controlled as possible but if using more ventolin makes it work as expected I guess I just don't understand why we can't adjust my asthma plan a bit. I want to be following the plan as much as I can but this is meaning that I'm going in to red every time I remember to use the ventolin just because of the amount of puffs so my options are to ignore the plan and not take it till I feel better or ignore the part of the plan to call 999 unless I want a paramedic out every day! I would go to hospital if I felt I couldn't get my asthma under control and was struggling to talk but I don't want to be there every day! Frankly hospital is stressful and my breathing is worse when I'm stressed so why would I go to hospital when I know I'll be back to normal after a few more puffs?

I'm not trying to be difficult I just want to understand, I've even being trying to find out how they explain this to people with learning difficulties to see if that'll help me get it, despite having no problems there, I've got a degree level understanding of medical science but it seems this only extends to other people not me? As this part is completely baffling me

[bluecar15 in reply to bluecar15]

I've seen the affects of too much ventolin and I'm not getting shaky at all so I was under the impression I was well within a safe amount for my body and that there don't tend to be manifestations of overdose other than the shaking, so without its presence I was in no danger of overdose

[bluecar15 in reply to bluecar15]

Oh one last thing, my preventer is seretide 125 2 puffs night and day and I've noticed that if I've got flare symptoms before I take it, I get much more relief from the seretide than the ventolin so I did ask the nurse if I could switch to Salmeterol but she said it can't be used as a rescue medication which also confused me a bit

[Lysistrata Administrator Community Ambassador in reply to bluecar15]

Just in case this gets lost below - some people use a longer-acting reliever like salmeterol, in a combined inhaler with their inhaled steroid as quick relief as well as a preventer, instead of Ventolin. This is if they're on a MART (maintenance and reliever) plan, but it can't be used alone without the steroid, as it isn't safe. Seretide isn't designed to be used that way, but you could perhaps ask if Symbicort or Fostair used as MART is an option for you.

[Pipswhips in reply to bluecar15]

Go get an appointment with your asthma nurse and ask for a asthma review and get your action plan updated. Ive been trying for years to get my asthma back under control and still fighting. Waiting for results from ybe ct scan consultant asked for to see waltz going on in the smallker tubes inside of my lungs andto see if change of meds or extra inhaler needed.

[Lysistrata Administrator Community Ambassador]

Hi, I won't address all your points but there are two quick relief medications usually used for asthma, which both work the same way: salbutamol (Ventolin is the branded version and comes in different types, like the spray and dry powder) and terbutaline (Bricanyl, also comes as dry powder and spray versions as far as I know). Some people prefer the dry powder but I also find it hard to use when my asthma is worse. Some people I believe don't respond to salbutamol or can't use it for some reason, so they use terbutaline.

They both work to relax the muscles round the airways which contract as part of the 'end result' of asthma. They do this by attaching to receptors called beta 2 receptors and making the muscle relax and stop tightening the airway, so these treatments are often called beta agonists. There's more than one way that you end up with the airway narrowing in asthma (and the airways in acute asthma also become inflamed and filled with mucus which narrows them). This is why there are a lot of different medications to prevent it and why you also need to tackle the inflammation in an attack, usually with steroids. But for acute treatment a major part is getting the muscles round the airways to relax . Some people use a longer-acting beta agonist like salmeterol along with their inhaled steroid as a quick relief as well as a preventer - if they're on a MART (maintenance and reliever) plan, but it can't be used alone without the steroid, as it isn't safe. Seretide isn't designed to be used that way, but you could perhaps ask if Symbicort or Fostair used as MART is an option for you.

There are other ways to address the airways narrowing that may be used in some circumstances, but as far as I know the beta-agonists are preferred for being quickest and most effective in asthma to relax the airways, and other methods are used if that's not enough.

In terms of inhaler techniques (your comment below in italics) - I would say do what works for you!! As long as you're using a safe and effective technique then keep doing it. I believe what you're referring to is called tidal breathing through a spacer and it can be easier for some people. I'm able to do breath hold or tidal but I prefer tidal and it seems to be more effective for me.

As far as the nebuliser goes - research suggests using a spacer and inhaler is just as effective most of the time, so mostly people are advised they don't need a nebuliser. When asthma is really deteriorating then a nebuliser is more effective (from personal experience, it definitely does work when inhaler/spacer isn't), but in the UK, apart from specific people who may have a home nebuliser as discussed with their consultants, asthmatics aren't advised to have home nebulisers. For most people, if they're at the point they need a nebuliser and not just a spacer, they need to be in hospital - some people have died from using the nebuliser until it stops working and then they're at home instead of hospital where other treatments can be quickly tried.

The only things which generally go in nebulisers for asthma are salbutamol and ipratropium (Atrovent) - which you can get in an inhaler; it works in a slightly different way and a little more slowly to loosen the airway muscles. I had a consultant who preferred it for some reason; it seems to be more often used in COPD as a reliever. There are longer-acting versions such as Spiriva (tiotropium) which some people with asthma take as a preventer.

As a child I'd use a big spacer with a mask and just breath in and out in the spacer with a puff of ventolin being added every minute or so till I felt better and so that's what I do when I'm ill and its affectingmy asthma. I assumed this was what the drs had told us to do and I'd just kept doing it but i had a search and most people do not seem to use their rescue inhalers like that at all! Theytake one puff and they are fine. There's no extended breathing in and out. I can't take a big inhale if my asthma is bad because of a chest infection or something as I need to take it slowly to get it in and further down my airways or I'd just cough it straight out. A few people seem to be using their Diffuser like this but they are saying they are using 'the volumatic as a nebuliser' so that got me wondering why they aren't just giving them a nebuliser to use and also what is put in a nebuliser, I think one is just ventolin but are there others? If so, can't I get one of those in an inhaler?

[bluecar15]

Thank you! You've made things a lot clearer for me, having a look, ipratropium isn't licensed for asthma as a rescue inhaler so presumably that's why she hasn't offered it to me?

I have spoken to her about changing inhaler as I'd like to reduce my inhaled steroid load so the microparticles in fostair seem like something worth trying but while she seemed really positive towards us working towards me being stabilised and taking my inhaler enough to change at the start of the first appointment, when I mentioned that if I followed her plan we'd be meeting constantly (I'd previously had no idea I was supposed to be going to the drs if i had a flare up of asthma and no chest infection) she started saying that she refers people who are having to come often to the hospital and that once that I'm taking my inhaler more it'll be controlled and I won't have flares very often.

But today she didn't talk about me working towards better control at all, she seemed happy with my compliance this last month (symptomwise I've made no improvement but I guess I need a few more months of good compliance?) And told me to carry on as I was. I said that I tried to only use 2 puffs but it honestly wasn't worth taking so could I go back to my usual? She didn't say no or yes to be honest, just that me needing more puffs indicated bad control. Then she said that she'd see me in a year unless I had a flare as per my plan and I said that my aim is still to move towards reducing my steroid load so I would still like to try montelukast (last time she was really happy to try this and said I could try it when I'd had a month's of as good as I can get compliance) but she seemed confused as to why I'd want to try it and when I explained as last time (it may be beneficial and help control my other allergic conditions, as my asthma has historically been linked to my allergies, montelukast may help control that area of inflammation meaning I may be able to lower my inhaler dose) whereas before she agreed and was positive towards it as an idea, this time she spent ages explaining asthma needs steroid inhalers and I can't go off them and when I agreed and said I just want to be on as low steroids as possible considering there being no end in sight and me having taken them my whole life, she said they wouldn't even reduce my inhalers if with the montelukast I was well controlled. I only want to try the montelukast, it may well not work but I don't understand why if I was not well controlled on seretide and montelukast we couldn't look at me having less seretide and still taking the montelukast. In the end she agreed to see what the Dr thought about me trying montelukast if I agreed I wasn't doing it to reduce my steroids as that wouldn't happen? That was a bit odd to be honest but maybe I'm just misunderstanding? I asked if I could book in see her in a month or 2 to see if I was better controlled and she told me that she would always be avaliable for me to book an appointment or I could just speak to my GP as the montelukast was up to him anyway. My GP is great but not with asthma tbh which is how my asthma got so badly controlled anyway (well, as well as me just not getting it and the last asthma nurse not being great) he always says to speak to the nurse about asthma as she's the expert whereas he's generalised

I did tell her I was waiting on a allergy referal and maybe they can look at my asthma? But I'm not sure they will? And she didn't really say they would or wouldn't

Do you think she's backed away a little bit and wants me to go to the Dr as she thinks my asthma isn't going to be able to be controlled in primary care? I'm a bit worried about this because I'm not sure if I'm explaining things right. I really don't think my asthma is that severe even if it isn't well controlled and honestly mine is the most controlled of everyone I know (I know I shouldn't compare! And them not being controlled doesn't give me the option! But the vast majority of my family are asthmatic (all at the level of dual acting steroid inhalers) and I'm far more on top of it than them even with my compliance issues! My parents have both decided they've cured their asthma after going down 1 clothes size and don't even carry rescue inhalers anymore, let alone taking their presenters and I know one of them was a dose higher than me on seretide prior to this, my uncle takes his preventer OK I think but doesn't seem to know he needs a rescue inhaler to carry as well, my grandparents had worse asthma than me but where on lower doses of inhaler and the Dr never considered upping them. And none of them have ever had a life threatening attack, only chest infections and the like. I'm worrying that I'm just not explaining my symptoms well enough and I've made the nurse think that it's worse than it is. Every time I give her an example of what my asthma is like when it's bad she says I should have been in hospital! I know my families asthma control isn't what 'you are supposed to do' and I want to control mine better than that but I want to live my life I don't want to keep calling 999 and going to hospital all the time like I think she's suggesting (or maybe I'm misinterpreting her?) We do all live in the same area, do we just live in a place where none of the nhs understand asthma? That seems unlikely (though actually tbh our asthma morbidity rates are not great but we're in an area with mostly retirees so I've put that down to a higher rate of asthma morbidity in older age. I don't know what the right thing to do is it's all so confusing!

I've just realised that I've massively diverged from thanking you, which was very much my aim! Please don't feel you have to reply, I really appreciate all the help you've given me already here and on other posts and honestly wouldn't have gone at all had this group not been so helpful, so I should be glad of the improvement I have seen!!!

[Troilus]

Hi bluecar,I can see why you are feeling a bit confused. Your asthma nurse doesn’t seem to have made the plan for your care very clear.

I understand you have show compliance with your inhalers - is this just the rescue inhaler?

Are you taking your preventer as prescribed?

The way I have understood your post is that you are taking your preventer inhaler as prescribed but you are not using your rescue inhaler as soon as you become symptomatic?

If that is the case, have you tried taking it as a regular/ routine inhaler ? That way you could set a recurring alarm on your phone. The effect of a blue inhaler is that it lasts four hours.

The thing I don’t get, is that you need to show compliance with your blue inhaler. The idea of asthma management is to get control so that you rarely need your blue inhaler.

Using a blue inhaler will temporarily open the airways but that is not solving the problem long term. In order to solve the problem you (we 😁) need to reduce the inflammation in the airways. A higher dose preventer is some thing that comes to mind, possibly a mart regime where you use your preventer more than the standard twice a day.

A course of steroid tablets is something else that comes to mind and/ or a LAMA inhaler, which keeps the airways relaxed.

I think your suggestion of Montelukast was a good one as is the allergy testing you mentioned. This will help you to identify things that cause a reaction in your airways.

I think that the best thing to do would be to give the asthma nurses here at asthma U.K. a ring and talk all of your concerns through with them; see what they would think is the best course of action for you and then you can discuss that with your GP.

[bluecar15 in reply to Troilus]

Thanks for your reply! The compliance issue is with my preventer, the seretide. My control is bad, partly because of this and also maybe because the med isn't working for me but they've never really determined that as they say 'come back when you are taking it 100%' and that has never happened (been on it for a decade) because I'm not taking it because I don't want to, but because of my neuro condition.

But then I also don't take the rescue one even if I need it and so the surgery had no record of how often I needed it and assumed my asthma was well controlled (I was attending with bad chest infections multiple times a year and telling them the infection was making my asthma very bad but they'd just tell me that was normal for asthma? And to keep taking my rescue inhaler and that once the antibiotics cleared the infection I'd be fine. I was also telling them at each review that I was really struggling with compliance and really needed help as I knew my astma was badly controlled but they'd just tell me to try harder to take my inhaler ad prescribed and note on the system that all was fine? Honestly it's pretty strange I don't get how it's only now they are realising I've got poor control).

I'd pretty much given up on seeing the asthma nurse at my surgery as despite telling her constantly that my asthma was badly controlled, she did everything by peak flow and so would just tell me to try a bit harder with compliance as its important but not note anything. With chest infections I was under the impression that steroids aren't prescribed anymore for a bad chest as they stopped giving them to me years back. I even had whooping cough (despite being vaxxed) and thanks to the combo of that, my asthma and a series of secondary infections, I was barely mobile because of a weak chest and was staying at a relatives as I didn't feel safe to be alone, after waking up one night unable to breathe or talk at all with severe chest pain, paramedics where called out (in retrospect this was obviously my asthma, especially as I was better when they arrived and they determined I'd just strained a chest muscle??? After I'd been attempting to take multiple doses of ventolin while waiting for them so it must have just kicked in eventually once I managed to get it in.) And wasn't even prescribed them then! Only a 3rd antibiotic to try and clear the infection. When I asked if there was anything to help my chest as I'd had steroids in the past to help the weakness after being ill for much less time (this happened when i took a quick turn for worse in the 3rd month of the W.C) and the Dr initially tried to prescribe me a steroid inhaler and when I reminded him I already took one morning and night as I had been my whole life and asked if this was an additional one, he told me that if I was already on a inhaler that was fine and to carry on as I was! I even asked if he could increase the dose temporarily considering how bad my chest was and he refused. My surgery are really just not great with anything chest related which is why I'd been kind of dismissive of how serious asthma can be. I've yet to meet a GP who seems at all up to date with asthma and understands that not everyone wheezes and peak flow against a standardised chart won't work for everyone. I'd at least been reassured by pulse oximetery not being susceptible to human error (as long as the machine works lol) when I feel like I can't breathe and they say I'm fine, but apparently that isn't even a good measure in asthma as spo2 often doesn't drop till the end. the 'respiratory specialist Dr' at my surgery I refuse to see as he managed to miss 2 major chest infections when I was a child (labeled them mild colds) when at least one turned out to be pneumonia after I was rushed to be admitted to hospital 2 days later. Since then I've known him to miss cancer in multiple relatives, one of whom died of it, so whilst I'm willing to allow people to learn, I'm pretty secure that I'm being fair in my choice to not see him!

The new asthma nurse has at least addressed this and I'm now to double my preventer for a week and visit her. She said all my asthma exacerbations caused by chest infections need to be logged as asthma and if the person I see doesn't do so then to visit her. (Though to be honest I've been getting hardly any since the pandemic! Hoping to carry a few social distancing lessons forward so I can actually experience winter going forward rather than spending half of it convalescing!)

I'd been getting a little worried about the allergy referral being lost but an appointment letter arrived today! One step closer to not dying from my food allergies!!!(the referal is technically because of multiple anaphalactic episodes over the last few months that I can't figure out how could have been avoided as I'm sure I hadn't ingested any of my allergens) and I'm going to try and get them to look at my allergic conditions a bit holistically as even without the food allergies, it seems a bit ridiculous for me to be taking 3 seperate steroids for 3 different conditions all with a allergic nature (I want them to look in to their being a root cause and look to treat that, not just layering on steroids to each manifestation of the inflammation, I'm sure there is one as systematic antihistamines help symptoms of all 4 atopic conditions one of which is the asthma, my hope is that if a root cause is found and targeted systematically I can reduce the dose of each steroid!)

I think you are right that the main concern is going to be getting control overall, that's what confused me tbh as I thought me and the nurse where on the Same page about my treatment being tweaked, she just wanted me to try my absolute hardest with the seretide first so she could see how I was with that and then she would start working with me to tweak things but when I went to the 2nd appointment she started saying she'd see me in a year!

I'm glad you mentioned those few other options as they are along the lines of what I was thinking! My main problems with my asthma are exacerbations which start with a tight chest, then shortness of breath (i feel like i can only breathe really shallowly), then a continuous cough, if not addressed at that stage I'll get a headache, feel lightheaded and eventually the cough is non stop and ill feel like I'm choking/gagging. I also always seem to have mucus though I rarely bring it up, it does feel like it's always on my chest just stuck If that makes sense? If I'm not ill at the time it'll be clear and it always tastes just like metal though there's no blood or anything. More than that though I have allergic rhinitis and get problems from mucus like at the back of my throat and sinuses so that's one of the reasons I wanted to try montelukast as mucus is one of the things it helps with plus I've got mast cell issues and montelukast is one of the meds they suggest as it helps with systemic symptoms plus itching which is a major problem for me (I'm on Like 4 meds for that alone so obviously I'd rather be on one thing that helps 2 conditions than 4 things that help 1). Because of the mucus problems LAMA's are one of the things on my consideration list and if the montelukast doesn't work i thought about mentioning trying it.

I've also thought about trying fostair again (they put me on it without checking my age when it first came out and was only licensed in adults and took me off it after realising lol) and that maybe a smart regime would be worth trying if the ventolin isn't working great as a rescue inhaler. Tho tbh I'm unsure about having getting extra steroids from my rescue med if there's another option. Having the rescue one at a set time is a interesting thought and it made me think maybe I can see if I can have a higher LABA dose as that's kind of what my seretide should be doing right? Working as a scheduled broncodilator.

I also think you are right with giving the asthma nurses a call, I'm going to wait and see how it goes when the Dr gets back about the montelukast and see how the asthma nurse is next time I see her (as presumably the Dr will tell me to see her before a year if he's trying me on a new med lol) and if I still don't think we are on the same page and I'm getting confused I'll see if the asthma UK nurses can help me with a plan of approach, maybe she was just having a bad day? And I wasn't Having a good day (set my asthma off rushing to get there lol) so communication was probably suboptimal. I'm really hoping that if I try the montelukast and it helps then I'll be better controlled I can look at moving on to a smaller particle inhaler and my hope is that if I'm better controlled as a whole It may give the ventolin a better chance and I won't need so much? Then it's not going to be an issue even if she's still saying 'it's bad to take that much of the ventolin but also don't take less than you need to feel back to normal' which is what is mainly confusing me if I'm honest!

[Troilus in reply to bluecar15]

You sound like you have developed a good plan bluecar, at least it seems like a good plan to me.Fostair is a good idea not only because as you say it is smaller particles and you can use it on a spacer using the tidal breathing method you prefer.

If my experience is anything to go by you will (hopefully) be given that to try before they add on anything else. I think it was about 8 weeks for me.

I suppose the nurse was wanting to know if a change inhaler was necessary. Maybe her thinking was that if you take your current inhaler as you should then that might do the job.

You could always set an alarm on your phone to remind you.

I do it by fitting it into my daily routine, but I have the advantage of not having to go out to work.

I get up, take a couple of blues to open my airways. Then I have a cup of water and take my antihistamines. At 9 I take my Fostair, have another cup of coffee. At 9.30 or so I take my Spivira Respimat.

Maybe you could build your preventer into your routine, so that the action reminds you to take it?

So get up blue inhaler. Have a drink. Preventer. Brush teeth.

That way having a drink might remind you to take your inhaler and brush your teeth might remind you you haven’t had it .

I also understand your reluctance to have a higher dose of steroids of any kind. However, I think you may need a higher dose until you get good control, then you can reduce down. The nurses comment about taking too much blue inhaler but to take as much as you need can be confusing. Like you, I have had patches where I use/ need to much of the blue inhaler. I remember in a consultation with my GP GP telling him I was taking way too much - I think I was taking something like 17 fairly often. He agreed I shouldn’t need that much and prescribed me some steroids, but told me to “ continue pushing the blues” until things improved.

I think that is the advice the nurse was giving you -you shouldn’t need to take that much, but continue taking what you need until your asthma is stable.

Anyway, as I said at the beginning, I think you have come up with a good plan. I hope it works out for you.

[peege]

A few years ago it transpired that I wasn't taking preventer Seretide correctly via spacer. Several years of pneumonia & infections later (probably due to airways not being open enough). Three years ago a great respiratory nurse changed me to Fostair a MART inhaler which for me has been totally brilliant and rarely need ventolin. I've always understood that if you're taking 10 or more puffs of ventolin then one's asthma isn't sufficiently controlled. Mine certainly is with Fostair however, we're all different.

[bluecar15 in reply to peege]

Yeah the main goal is definitely to get better control long term and I get that the 10 puffs is indicating that I'm not there so hopefully once I have better control preventer wise less ventolin will work?

I want to try a smaller particles inhaler as I'd like to use as few steroids as possible while staying well. I've been on fostair before but they shouldn't have prescribed it to me (didn't check my age and it wasn't licenced at the time) so I got taken off it shortly afterwards. I understand you don't have to keep it in a fridge once it's opened anymore which is good. If I can't get to a stage where the ventolin is working as expected maybe mart will be the best option? The only thing I've got against fostair is I really don't like the taste of Beclometasone which I know is a ridiculous consideration but after 20 years of varying inhalers I've started to notice and rate them, even if it's going straight down lol seretide is much nicer to take

Its interesting you say about the spacer as I had the same thing when I changed to a small spacer, I'd been doing breaths in and out with a volumatic my whole life at that point and so my 1 inhale with the aerochanber was way too quick and I didn't know to hold my breath. It worked so much better when I realised but it took a long time! They'd kept increasing my dose without checking my technique properly. I know it's a bore and people think it's patronising and a waste of time but I really think it's a worthwhile part of a review!

[peege in reply to bluecar15]

Yes, staggering that we can use preventer so poorly it's not working properly, in my case it was 3 years 🙄Yes, Fostair is smaller particles. If I'm going on a lone walk I'll have a puff of it before I, eave and it was great in early summer when I needed to up the dose due to air quality.

Good luck to you for the future

[Shelleyblue]

It's possible that you need a change in asthma medication and not more or a higher dose of ventolin ! Has your asthma nurse suggested you try aa different asthma medication ? I changed to fostair inhaler and it made such a difference to my asthma. I'm much better controlled now.

[bluecar15 in reply to Shelleyblue]

Yeah I'm hoping that when I'm better controlled the ventolin will work as expected! She hasn't but I have lol I've got to get to a stage where we can switch first but in the meantime she's very hung up on the multiple puffs and I don't know if she wants me to just take fewer and have it not work? Or carry on as I am and just see it as a sign that I'm right and my asthma is uncontrolled and it's good that we are working on fixing it?

[Pipswhips]

I was told if bad take your blue inhaler every2puffs 6o secs to relieve your attack if it dosent repeat and get ambulance out.One time years ago 1 dr who came out it was when your local gps came out he told me to put 20 doses of blue in thd spacer and breathe in only problem was you get the shakes but it did calm me down and when i was on the inhaler im on now i used to increase my steriod inhaler to another 2-4extra doses but now a days i cant do that they rather give you steriods but the extra doses of steriod inhaler usually did the trick for 4-7 daysof extra

[bluecar15 in reply to Pipswhips]

Yeah call an ambulance if it takes more than 10 puffs is what my plan says and I've said to her I really want to follow the plan but I'm really not that unwell when I use 10 puffs as I always need more than the 2, me taking 10 wouldn't be a sign I was rapidly spiralling or particularly breathless. I've been told to take it whenever I feel any symptoms so mildly tight chest, out of breath, chest pain, asthma cough starting.

I guess in an ideal world I just want my plan to be a bit more realistic to a level where I will follow it because I understand I wasn't being cautious enough and I'm willing to call them if I'm 'can't talk' level of breathless and it's getting worse not better but at the moment there's no way I will follow it because I'd have paramedics living here! Knowing that 10 is the limit would put me off taking enough to feel better but 99% of the time I can take 10 and get on with my day, symptomless.

Yes I've always done something similar! I've had asthma since i was a baby so I don't remember where I learnt it but I use a big spacer to take normal in and out breaths, I don't do 20 at once, I just add one dose at a time and add another when the chamber is empty till I feel better. The small breaths mean I don't cough it straight out like I would with a deep one. Its the only way I can sleep when I have a chest infection even propped up and Everything. I've heard something similar referred to as using your spacer like a nebuliser? And I think the smaller breaths are tidal breathing maybe? I think this is why it never occurred to me that taking many puffs was an issue as I've always been taught to take one after the other till I feel better. The only thing I've ever worried about was taking enough to get the shakes that you mention, but that's pretty easy to avoid if you are taking 1 at a time I've found. If you take enough to get shaky you can also get heart palpitations. I guess I need to just get used to the new way of things!

[Pipswhips]

Make an appoiment with your asthma nurse and get your asthma reviewed and discuss your feelings and fears also ask for a new action plan.Ambulances dont mind coming out to you if your bad they can check you if necessary the can get a dr to ring you if the dont think you need to go to hospital also they will talk to you and advice you what to do they dont mind they told me they rather come out to then a drunken idiot or some druggie who decide to take to much illeagle drugs

Hope this helps you bluecar