Ventolin question

[challny]

I have emphysema/asthma and am on 3 inhalers, Spiriva Respimat, Symbicort and Ventolin. The Ventolin seems to help the most with my breathing (I think). What I'm wondering is how much and how often can I use it? My lung doc says 2 puffs every 4 hours as needed. But I've seen some conflicting info online, that is some people who take more than 2 puffs and if some of you think that helps and is safe to do. Thanks for any input.

[stone-UK]

Hi

At a recent respitory team referral, I was told to use it four times a day 2puffs, morning, noon, evening bedtime and any time in between.

I am stage four emphysema/slightly bronchi.

Which is fine if you are not affected by Ventolin, can cause shakes and palpitations.

Take the advice of your lung doc who knows you and your medical history.

If do have issues there is a alternative.Bricanyl

Mist inhalers are best with a spacer, you get more of the medication to the right place.

[challny in reply to stone-UK]

Hi, Stone, and thanks for your reply. But I'm still confused. What I was wondering is if you could take more than 2 puffs at a time. Today, for instance, I took 2 puffs before going to the gym. That was about 1 p.m. I didn't use Vetolin at all before that. Now it's almost 5:30, and I still have not used any more Ventolin. So, suppose I needed some at 8 pm. Could I use 4 puffs -- an then no more? The other thing that confuses me is sequence of meds. I have heard two different schools on this. One, take Ventolin first to open your airways, and then take your preventers. But I've also seen the opposite said. Please understand, I'm not trying to be contrary, I'm just seeking information. My lung doc spends about 1 minute with me when I see her, so I don't get much information from her. The last time I saw her, just a couple of weeks ago, she said my illness was mild. The time before that she said I was moderate. She's very kind, but I don't learn much from her.

[stone-UK in reply to challny]

Hi

If you feel you don’t need it, then don’t use. Using before the gym or any particular excertion is recommended.

As you say you are border line mild, moderate so you will probably not require as much use of the reliever. Use you own judgement. You don’t need to catch up on the dosage.

All of your inhalers are manufactured by different companies, and are designed to be effective without the use of a secondary inhaler to pre open the airways, it’s not mentioned in the how to take instructions.

Some people swear by it, others don’t, in reality it is a persons preference. I don’t.

[Hidden in reply to stone-UK]

2 separate pharmacists have told me that taking too much of Ventolin only makes sob worse. The dosage is a fine line and anything over that accentuates the symptoms we are taking it for. When we inhale it it makes our hearts race. I went through a period of using it a lot and didn't realise that was why I couldn't write anymore....I had to ask post office to address parcels I was sending. I shook so much.

[stone-UK in reply to Hidden]

Hi

I did mention in my first reply that Ventolin ( salbutamol ) can cause palpitations and shakes, the alternative is Bricanyl (terbutaline)

Ventolin ( Salbutamol) is given as treatment via nebulisers in hospital,my two admissions I was given Salbutamol three times a day for three days. Equates to a daily dose of approximate 30 puffs. Under supervision.

[Hidden in reply to stone-UK]

HI stone-uk.....I noted what you had said about Ventolin causing shakes etc. I was merely confirming that it had that effect on me when I had been unwittingly overdosing on it. 😄 Idiot that I was but I hadn't realised I was shaking and had been for months so my husband later told me. I'm very wary now. I will ask respiratory nurse about Brycanl. THanks 💐

[music]

Hi challiny.

It is all confuseing to me has i was diagnosed with copd 5 years ago and have been on ventoline has and when i get breathless or wheezy and i have been takeing my ventoline before i go to bed just one puff and then in the morning or in the night if i wake up a bit breathles or wheezy and i am fine after a few mins for sometimes up to 9 hours

One container of just ventoline can last me 2 sometimes 3 months at the momemt , but i have just been put on spiriva capsal inhaler once a day, and i cannot understand why if just my ventoline is at the moment ok and suits me

nurse said to still use my ventoline if needed

I know we have to go by what our gp say or think BUT i do know my own body has well and not sure if i need to put differant meds in my body at the moment if not needed yet

All the best

Music

[PhoebeIsMe in reply to music]

Can I please ask you a question? I'm terrified, my husband was diagnosed with Emphysema 2 months ago. they found it during a routine chest X ray he has no symptoms yet. How long will it take before he starts getting SOB? he is a former smoker hasn't smoked for 22 years. I'm wondering how fast it progresses.

[music in reply to PhoebeIsMe]

Hi PhoebeisMe

I was very scared when first diagnosed with copd but you do learn to live with it has it will progress very very slowly if he looks after himself, but everyone is different.

If you look back at members past posts on this site and other information here you will see your question has been ask by many people

Your husband dont smoke and has no symptoms yet so i would think he is at the very mild stage and if he can keep has active has he can and do the right things looking after his self , i think he will hardly notice the progresses of this copd

Has for me exercice and keeping active has been the key thing and really helped me but has i said every one is different

Keep on this website has you will get very good helpful knowlege and information from very helpful people on here.

Very best wishes

Music

[Hidden]

To specifically answer about whether you *can* take more than 2 puffs at a time, absolutely. The maximum single dose of salbutamol is 10 puffs, however, at the point you needed 10 puffs you’d also be making arrangements to be urgently reviewed and/or getting yourself to A&E, as that would be classed as a serious situation for most people. My daughter has cystic fibrosis and she routinely has 4 puffs, both to open up her airways pre chest clearance morning and night, and in the rare event she needs her ventolin because she’s breathless or wheezing. If she’s had a particularly bad exacerbation where her small airways are really inflamed, with medical approval she’s had 4 to 6 puffs every 4 hours until the oral steroids have started to kick in. The point here is that your dose must be based on your doctor’s advice, and if you feel that’s not working, or not working enough to give you good, consistent relief, then you need to have that conversation with them. It is worth mentioning that sometimes, taking the prescribed dose regularly, even if you don’t actually need it there and then, can work for some people to ensure they don’t suddenly find themselves in need of a larger dose later in the day, but again, that’s a conversation for the docs.

I don’t know if this info is useful to you, but based off your post, ventolin and Symbicort work differently, which is why you’re finding ‘greater’, more immediate relief with ventolin. Symbicort is a steroid based preventer inhaler, meaning it’s a long acting drug designed to keep airway inflammation to a minimum - it works away in the background to improve overall airway openness, which is why you only need to take it twice a day and why you probably don’t notice the effect. Without it, you’d likely find that you were struggling a lot more due to the small airways being constantly inflamed and therefore in need of more ventolin. Ventolin is what’s known as a relief or reliever inhaler, and is a very quick acting bronchodilator, which means it acts to immediately open up the airways and (hopefully) help there and then. That’s why you can use it throughout the day and why it’s carried everywhere by those with asthma. The advice from my daughter’s respiratory team has always been use ventolin first, then Symbicort (or whichever preventer she’s been on at the time), but the opinion on this seems quite evenly split depending on who you talk to and to some extent whether or not their condition warrants chest physio. One thing everyone agrees on though is that you should rinse your mouth after steroid inhalers.

Hope that helps.

[E10ly in reply to Hidden]

I’m a bit confused here, I take salbutamol and according to my Doctor I don’t have to worry how often I take it as when you have to use a nebuliser that is a hundred times the dosage in my inhaler! The only time I had any sort of reaction was a headache after a lot of use, but this subsided once I got up in the morning.........so maybe different horses different courses?!

[Hidden in reply to E10ly]

I’d agree with that to a limited degree - if you’re taking a puff or 2 very frequently, I’d argue that needs to be looked at as it would suggest the underlying condition isn’t being well managed. Under normal conditions, Salbutamol is generally considered to work for between 2 and 5 hours post dose. Different illnesses are indeed different and sometimes warrant a different approach, but there are some general themes that underpin all respiratory illnesses and trying to manage wheezing and shortness of breath is one of them. I know NHS direct is very generalised, but it does actually state that ventolin should be used no more than 4 times in 24 hours to a maximum of 8 puffs (800mcg) regardless of underlying condition, and the BNF concurs with that guidance for the management of persistent symptoms. The exceptions are as prophylaxis for allergies or before activity, during acute events/attacks or in severe cases, and obviously if under direct medical supervision. The general advice is that if you’re routinely needing your inhaler for relief more than 4 times a day you should speak to your doc about options to better manage your condition - when littleun has been massively unwell and wheezy in the past we’ve ditched the puffer and cracked out the nebs as they’re more effective than a puffer when symptoms are hard to control. If someone needs a lot of ventolin on a regular basis, it could be a treatment needs to be added, or a preventer changed, or a switch in delivery of ventolin.

[music in reply to Hidden]

Hi charlie-G

Very intresting reply to challny post,.. and i know they are very busy and dont have much time but just wish some docs or nurse would sometimes explain some things like you have in your answer to this post.

Best wishes

Music

[Hidden in reply to music]

I do a lot of research and reading anyway, but I said on a post yesterday that it’s also one of the ‘perks’ of coming at things from a parent’s perspective - paeds staff are much more inclined and willing to explain things than adult medics, if only to get panicking parents off their backs. The nurses have answered so many of my questions and explained so many things to me over the years, I could genuinely pass my asceptic technique and infusions training at this point. I could also correctly access my daughter’s portacath if I needed to - at least in theory!

[2greys in reply to Hidden]

You have just echoed the same advice that the doctor gave me when first taken to A&E with breathing problems, subsequently diagnosed provisionally with COPD after an X-ray showed hyperinflation. I had asked the exact same question having experienced not being able to breathe in or out properly and very scared about it.

[challny in reply to 2greys]

Hi, @2greys. I obviously don't know that much about my condition, but I've figured out that I do have hyperinflated lungs. I'm noticing that docs are somewhat reluctant to give you the whole story. When I was first diagnosed by my GP, he showed me my x-ray and said I had "long lungs." When I mentioned this later to my pulmonologist, she said, well, some people just have longer lungs than others. Then, one time later, I saw the lung doc's nurse practitioner and she said (for the first time) you have hyper inflated lungs. Some months later when I was going over my breathing test numbers, I said to my pulmonologist, "so, I have hyperinflated lungs," and she said yes. This was at the time she was telling me lungs looked good and I should not be feeling as poorly as I claimed. So, I'm very confused. But I'm assuming now that my SOB is because I retain C02 due to hyperinflation, which, I also assume, is part of emphysema (or asthma; the doc said I have both.) Obviously, I don't know much, except that I feel pretty crappy most of the time.

[2greys in reply to challny]

You know a lot more than those who do not know of this forum and are just left floundering to their own devices to suffer in silence. Those who have dismissive GPs that know little about our conditions.

Yes, hyperinflation is caused by air trapping, the obstruction means that you cannot breathe out properly but you still try to breathe in the same amount as if healthy on top of the trapped air. This over inflates the lungs causing them to stretch, with emphysema the lungs lose their elasticity, so after being stretched they cannot shrink back again.

So imagine a balloon that has been blown up really hard and then the air is let out, it ends up all wrinkled, stretched and floppy, this what happens to our lungs. As you try to breathe out it collapses slightly creating pockets of trapped air/CO2.

Pursed lip breathing can help, by creating a small back pressure that helps to stop those pockets being created in the first place. This is a very similar principle to that of a CPAP machine used at night with a mask whilst asleep, CPAP=Constant Positive Air Pressure.

[challny in reply to 2greys]

I bet a cpap machine would help me sleep, because I have difficulty sleeping. My pulmonologist once said, "Maybe you need a sleep study," and that was it. She didn't say, "Let's arrange one." I played 18 holes of golf today, but I rode in a cart the whole way. My breathing wasn't that bad, but I felt woozy the whole time, like I might pass out. I've been feeling that way more and more lately. My breathing is not that bad, but I feel like I might just keel over. Very light-headed and wobbly. By the way, I had 6 pars, which is pretty good for me.

[Spacecat1 in reply to challny]

I went through same thing my go was hopeless eventuality I was rushed into hospital by ambulance had all kinds of tests done had a new consultant who has been brilliant my other one used to ask your of questions and that was it but this one has a good chat with you. He knows I have anxiety breathing attacks and he has been really helpful about things. Looking into an operation next year. Take care

[Ergendl]

Don't forget to leave 20 seconds or so between puffs of Ventolin to let the nozzle unfreeze. If you look up the mouthpiece after a puff, you can see the white frosting clearing. If you don't leave the gap, you just get a mouthful of propellant in the second puff, not the medicine.

[HungryHufflepuff in reply to Ergendl]

I've used Ventolin all my life and I never knew that! Thanks for the info.

[Ergendl in reply to HungryHufflepuff]

I only found out when I went to the Hanley Breathe Easy meeting - a lovely Nurse Practitioner visits there regularly to give a talk about living with lung conditions and demonstrating how to use the different inhalers. Sad I can't get there now due to running a singing group in a residential home every Friday.

[HungryHufflepuff in reply to Ergendl]

That's too bad, it's always disappointing when interests or activities clash time wise.

[Hidden in reply to HungryHufflepuff]

Same here ....😀

[Onionwoman2 in reply to HungryHufflepuff]

I have had inhaler years and never knew this was the reason. Thank you

[Nitap]

Wow thanks for that info !! xx

[challny]

Hi, everybody. These are all good answers. For a long while, I never used my Ventolin at all, but something changed in recent months. I think I have complained in the past that my inhalers do nothing for me, but it's hard to tell with the preventers -- unless you quit taking them altogether and then see if you feel worse. But lately I have felt that Ventolin does help me. Yesterday I used it twice -- 2 puffs before going to the gym and then I just rolled the dice and took 4 puffs in the evening all at once. As I and some others have noted, it's all very confusing. When I use it, I'm not gasping for air or anything like that -- just more SOB than usual. But I am at least a little SOB almost all the time. I remember when I started pulmonary rehab one of the nurses interviewed, and one of the questions was: Do you ever have moments when you feel like you don't have COPD. I thought about that for a bit, then replied, "No." But I do have better and worse moments. Anyway, thanks for all the info and I hope everyone is breathing easily.

[lKeith]

challny

Hi, I'm not familiar with symbicort (probably in lieu I have Fostair) it still means 3No inhalers. I have been given to understand that ventolin & Fostair are best taken with a spacer. There are 2 types, a short one and an a very large one. The belief is that you can take in the medication slower which is more beneficial. I medecate in the morning with all three then use the ventolin if required only when outside the house straight from the inhaler. I take as many puffs as seems necessary and don't stick rigidly to a fixed number. It doesn't do me harm but it does bring up a lot of mucus.

Try the GP for a spacer these are available on prescription.

IKeith

[challny in reply to lKeith]

Hi, @Ikeitch, so let me add to the confusion. First, you can order spacers online with out a prescription, and they are quite inexpensive. Second, I've heard so much about the value of spacers with MDIs, I actually asked my pulmonologist if I should use one. She said, not really. At this point, I don't know if I'm crazy or if my doctor is crazy.

[challny in reply to challny]

@Ikeith, one more thing. I do not have a problem with mucus. Coughing is not a component of my condition. I'm not saying never, but mostly not. X-ray always show "clear" lungs. My main symptom is SOB, and all that entails, such as fatigue and a general feeling of rubbish -- and difficulty sleeping.

[challny in reply to challny]

@IKeith, that's me exactly.