Nebulisers - should I get one/how do Doctor's feel about having them at home?

Hi All,

I would like to hear your thoughts and advice if I should buy a nebuliser and how you have discussed with your GP's in the past.

My son is nearly 3 and started having wheezy attacks from about 8 months - very scary and worrying, but we handled it with Salbutmol inhaler and Atrovent inhaler when he needed it. Normally only every 5/6 weeks after a change in the weather, trip to London, pets etc.

This week we got admitted to hospital for the first time and he had the nebuliser every 2 hours for about 10 hours to settle everything down. We were discharged yesterday and now just taking the inhalers every 4 hours (6/10 puffs), should be cutting this down after tonights dose. Just to add here - he hates the inhalers, we have to hold him tight to give which I know is not ideal !

My sister-in-law has a Son with asthma and has a Nebuliser at home, with Salbutmol (for the Neb) too. They bought it privatley and the Doctor percribed the medicine.

Having had to be admitted this week has made me think about getting one and raising it with the doctor, we're seeing him on Monday. It's not that I want to have it to use all the time, but now I know Adam's asthma well I think it will save time and stress of hospital visits. We did have a trip to A&E about 6 weeks ago but were not admitted. Previously he has only had the nebuliser over one weekend (via the out of hours doctor) - again, stressful and worrying waiting around for people etc.. We had to wait over an hour to see the Doctor on Monday, although once he was seen they were amazing.

Would appreciate your thoughts and experiences on this.

Thanks in advance !

Sue

18 Replies

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  • Sue, first I hope your son is recovering well. I can understand how you feel, but I don't think a home neb is the answer yet. It is dangerous road you go down when you get one as you are taking away the hospitals 1st line of defence. Many consultants beleive if a child is ill enough to need nebs they should be in hospital.

    Of course there are some children on here with home nebs but that is either because their attacks are so sudden and bad they don't have time to wait for an ambulance or there asthma is so severe that the only way to give them any kind of normal home life is to let them use a neb at home. With all home nebulisers for both adults and children there are strict guidelines that you must adhere to. These need to be drawn up with your childs consultant not your GP. After his admission you should have a follow up appoitment with someone from the hospital if not ask your GP for a referal.

    There is another consideration would you have wanted to be at home using a neb every 2 hours without the back up of all the facilities the hospital has if your child were to suddenly get much worse. An asthma attack can go from looking controlled to well out of control in a very short space of time, would you want that responsibilty especially when at 3 it is hard to them to explain exactly what is going on and to get reliable PF's when a child is in an attack and feeling off anyway.

    My best advice is if he is wheezy and the inhaler is not working or if the attack seems worse get him to A&E ASAP where the staff can assess him and look after him. I know it is frustrating when you think there is something out there that can help and you can't have it but there are very good reasons why the vast majority of children and adults don't have a nebuliser at home.

    Bex

  • Thanks for your reply and advice Bex. We'll have a chat to the doctors next week and see what steps he advises. Adam doens't have any kind of preventative medicine at the moment and that may be the way for us to control it for now especially during the summer months.

    Will let you know how we get on.

    He's much better today and has finished his steriods so fingers crossed we'll be make to normal soon.

    x

  • Susie, I am glad Adam is recovering. It is so scary watching your little one unable to breathe. I would have thought that if he is not having any preventers that is the way to ge before they start thinking about home nebs.

    Good luck with the Dr's don't be afraid to tell him your concerns, and it is worth writing a list I do cos things have a horrid habit of going whizzing out of my head when I get into the consulting room, more so when you have a lively 3 year old in tow!

    Bex

  • Hi Susie,

    So sorry to hear about how poorly Adam has been - it must be so difficult to see your child struggling like that, especially when he is so young and can't really understand what is happening to him.

    I would totally agree with Bex, though, that there are many many routes to go down before considering a home neb. I know when you first use a neb or see your child use it the instant relief it can bring seems magical and like the answer to all your problems. I do remember that feeling well! However, nebs are pretty strong medication (usually at least 2.5mg of salbutamol rather than the 100mcg that one puff of an inhaler provides - ie 25 times the dose) and of course the side effects can be pretty unpleasant, and even, rarely, potentially dangerous.

    Then there is the issue that having a neb, which really only treats the symptoms, not the underlying condition, may give a false sense of security and may prevent you from recognising and seeking help as soon as you might. By the time a neb is not working, it usually means that the asthmatic is in real trouble - and needs to be in a hospital right quick. A lot of the asthma deaths that occur in this country are associated with patients having nebs at home and overusing them when they should be getting themselves into hospital for more treatment. I think most doctors would agree that the vast majority of asthmatics, if they are sick enough to need a neb, should be somewhere where they are under medical supervision.

    Most GPs surgeries do have nebulisers available for use at the surgery, so it is not always a case of having to go to A&E every time. Some surgeries will even lend out nebs for a few days to get you over a bad patch - but again, this is done under strict supervision and with regular review by the doctors. Also, for most asthmatics, giving 10 or so puffs of salbutamol from the inhaler via a spacer (having discussed it with your doctor) is usually as effective as a neb (no flaming, folks, I said MOST asthmatics, I know that for some of us that does not necessarily apply!). I'm assuming that as he is only three, you do have a spacer with a mask. In terms of your comment about him being reluctant to sit still and use it, if you do a search in Parents and Carers you will find several previous threads about ways to encourage young children to accept and cooperate with medication.

    I have Type I brittle asthma, and have had many acute admissions, and it was still a long drawn out and carefully considered process, with many discussions between me, my consultant, my GP and my asthma nurse, before I was allowed a neb at home. I have it, as Bex says, partly as an emergency measure to get medication into me fast while waiting for the paramedics to arrive, and partly to allow me to be at home more - if I was in hospital whenever I was requiring nebs I would spend most of my life there! It is a balance, though, between maximising quality of life (ie keeping me at home) and being safe. I have carefully drawn up and strict guidelines about how many nebs I should use back-to-back and how often I can use it before I should be taking myself off to hospital. If you do have a home neb, it is very important to have guidelines like these - which should be set by a respiratory physician, ideally, not your GP - and to stick to them closely. It is important to be clear in your mind about whether using nebs is part of your son's regular therapy (very unlikely to be necessary) or whether it is strictly an emergency 'waiting for the paramedics' measure.

    I certainly would not go out and buy a neb at this stage. Some people on here have spent money on nebuliser machines only to find that their doctor does not feel that prescribing the medication to go in them is appropriate - an annoying waste of money! If a hospital consultant feels that your son does need a neb, the hospital will usually provide a basic one. Some of us do then go out and buy posher / quieter / more portable ones to make life easier, but it shouldn't really be necessary.

    In terms of the length of time that you have to wait to be seen by a doctor - I am not sure if you are saying that you waited an hour in A&E or at your GPs - but in most cases, if you let the receptionist know that you have a young child who is in respiratory distress, they will arrange for you to be seen pretty much immediately. Sometimes a little bit of making a fuss is required! It may be worth having your GP make a note on your son's notes that he is to be seen immediately if you bring him in when he is acutely unwell.

    Well, this is a bit of a long and rambling post, so I'll finish now (I am suffering from the effects of sleep deprivation, so I am not at my most coherent!). I do hope Adam continues to improve, and that they can find a combination of meds that keeps him from having the bad attacks at all. Contrary to the impression you might sometimes get from reading on here, 95 - 97% of asthmatics can be almost completely controlled, with minimal interferance with normal life, once the right combination of meds is found. Let's hope that Adam is in that group.

    Hope this helps, take care,

    Em H

  • Em H wrote:

    ""Also, for most asthmatics, giving 10 or so puffs of salbutamol from the inhaler via a spacer (having discussed it with your doctor) is usually as effective as a neb (no flaming, folks, I said MOST asthmatics, I know that for some of us that does not necessarily apply!).""

    I'll back you up, Em! This is especially true in childhood asthma, as an article I was reading in this week's BMJ pointed out.

  • Thanks all for your advice and replies ! Adam is doing much better (sitting on the sofa eating dry cheerios at the mo, NICE!). I feel more confident now on talking to the doctor and I' have started to make a list of things I want to mention. We have had the neb at the surgery before (the very first time he needed it at about 8 months old) - and following that they sent us to A&E as he needed to be kepy a closer eye on. I know A&E is the best place when he's bad as they can check his oxygen levels etc.. and don't get me wrong I'm not shy to take him even if I get sent away, I'd rather do that than wonder should I go or not.

    My husband is coming with us to the Doc's on Monday which will help amuse Adam while the other is talking.

    Again, thanks for your advice and keep you posted.

    Sue x

    PS - Adam is starting to take his ""puffer"" with less of a battle today, we count the puffs and we've stuck some ""Thomas"" stickers on it. :0)

  • Thanks, Steve, for the support... didn't want to get my head bitten off by all the brittles... that Bex scares me :-)

    I read the same article... I am very impressed at your reading material, though, if that doesn't sound too patronising. I can't get my hubby to read it most of the time and he is a doc!

    Maybe you should retrain... you would certainly be ahead of the game as far as asthma treatment is concerned!

    Em

  • OK EmH, thats you off my Edward Monkton random card list :)

    Bex

  • You're really too kind, Em! It just so happened that the BMJ decided to publish their childhood asthma articles in two issues just before we go to the Fareham Kick Asthma Holiday - it starts on the 19th August. I thought I ought to ""brush up"" a little in case any of the kids ask any searching asthma-related questions!

  • (he was gently sign-posted....) ;-)

  • Yes. I believe the phrase was, ""Oi, read this""!

  • I'll get Sean online this week researching some really searching asthma questions for you next week Steve ;) he he

  • Thanks"", Julie...!

  • *Actually*, I think the phrase was, ""I think you might like to read this"".

    Go Julie, go Julie...!

  • Have shamed hubby into reading them by reminding him that he is doing a Paeds job in a few months time, and has also expressed an interest in doing KA holidays.

    Actually, I feel rather guilty now - he's only just started work, so he's knackered enough as it is without me forcing him to do homework!

  • well I have read them now so feeling very smug. was something to do with 3hours of invigilating for resits today though!

  • Hi All,

    Just to let you know we had a good response from the Doc this afternoon, Adam is now the proud owner of ""an orange puffer"" as he calls it ( Flixotide ) which he'll use twice a day for the next few months. The doc seems to think that this attack was allergy related so while the summer is trying to confuse us we'll keep this going and hope it keeps another attack at bay.

    Thanks for your advice and stuff and I'll be back if I need any more.

    Cheers for now.

    Sue x

  • was told that ten puffs of ventolin a couple of times would have same effect as nebuliser but it has never worked for my daughter.lots of local doctors have suggested a nebuliser at home for my daghter but am unable to get one .it is viewed by specialist that if you have one at home you may not take your child to hospital when neccessary.this would be fine but at weekends and evenings if my daughter needs a nebuliser i have a half hour drive to the hospital in a panic in case her breathing deteriorates

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