Multiple Dosing

I'm beginning to wonder if I'm using my Ventolin + Volumatic incorrectly for multiple doses (10) when struggling, even though I've had my technique checked by GP and asthma nurse who have said it's 'perfect'. I was wondering if others had similar experiences.

I've always been told 10 puffs is the same as a neb. However, the relief I get from 10 puffs (one at a time with the spacer) is nowhere near the same relief I get from a neb. The nebs I've been given at the GPs and at costa have worked recently, when the 10 puffs hasn't helped much.

So am I doing something wrong? The only thing I can think that might be different is a more psychological effect in that when I've had nebs I've been with the GP/nurse so might feel safer which may help.

My consultant doesn't want me having home nebs because he wants me in hospital if I'm that bad which makes sense given my history - though I don't really understand why he's happy for me to do the 10 puffs/spacer thing if it's supposed to be the same thing?

I'm just wondering what I can do to make things better - I'm feeling pretty grotty at the moment and having to travel to GP / Costa to be given nebs isn't helping me get better - I'd be a lot better off if I could get that same relief at home without having to go out and being exposed to triggers, but I'm not getting that same relief from my Ventolin + Volumatic, so I'm obviously doing something wrong. Any suggestions?

30 Replies

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  • Hi Ratty

    I could have written that post myself! The amount of times I've been told that ventolin+spacer=neb... I don't agree! I generally feel so much better after a neb, I've put it down to the psychological effect, and also, if I'm struggling then using my inhaler and spacer can feel like hard work, whereas I feel that a neb is easier to breathe in (does that make any sense? it does to me :P lol).

    Sorry, I can't answer your question but I feel the same as you :)

    Dawn xx

  • Just a thought, but are the nebs you are getting definitely equivalent to the number of puffs you're putting through a spacer? I was led to believe that 10 puffs = 2.5mg neb, and that 20 puffs = 5mg neb. I think the usual adult dose in an acute attack is 5mg salbutamol so it might be that GP/ nurse are giving you a higher dose of salbutamol than you are giving yourself?

  • Ah Wherrers, you might have something there. Yes, when the GP gives me a neb (and hospital) it's always 5mg (and sometimes two of them), so that is a difference to the 10 puffs. Well I tried 20 puffs instead when having probs in middle of last night - maybe helped a bit more, not really sure.

    I think one of the other differences may be all the coordination required to do the 10 puffs, waiting the right time between them - and having to hold up the spacer when your body just wants to go bleugh...

  • okay i can defo help out here ratty - as a prof point of view and personal point of view!!

    10 puff = 5mg neb

    5 puff = 2.5mg neb

    however, when doing volumatic, i also find it very blooming tiring too. so what i do, is :

    1 puff, 5-10 breaths. breath to catch my breath. then repeat for each puff.

    works better and i get relief, maybe not quite as much as neb as its still effort breathing in / out isnt it...

    also may sound stupid, make sure the volumatic is straight and not at an angle ;)

    good luck :)

    xx

  • Okay, so I guess I'm doing it right, but it's bloomin' knackering when I need relief. My neighbour (who's a nurse) was with me this evening when I was struggling (again) and she let out a string of expletives followed by 'why are they making you do this, you need something more?' Trouble is, how do I get my consultant to understand?

  • i was trying to explain the same to my asthma nurse yesterday seeing as its so hard to take inh via volumatic with snuffly nose at the mo cos of hayfever as well.... feel even worse after, hmmm.....

    she couldnt suggest anything other than tidal breathing...?

    **sigh**

    x x x

  • Hi Ratty,

    Snowygirl and myself had a conversation similar to this a while ago when my son was really bad and had been on home nebs for just over a week and after returning machine to gp's surgery he went downhill again so I took him straight back to gp who this time said just multidose (as we do!) the ventolin via spacer (as we do!) and I believe gp advised that I could give my son 20 puffs as that would equal the home nebs I had been giving him (but he was having 2.5 nebule every 4 hours instead of 5ml nebule every 6 hours!).

    I was quite surprised at being told to give Louis 20 puffs as I always understood 10 puffs was max and that then you should be seeking immediate help............ I think Snowygirl was quite alarmed at what gp had said too (you see thats why this site is great because we can ask opinion of what others think)

    I also agree with you all that using a nebuliser is much easier, trying to give a child ventolin thru spacer when the child is distressed, can't breathe etc etc is damn hard work for both child and parent/carer (as it is for yourselves). I just think some gp's have their preference on the treatment of asthma, I think it should be uniform (unless ofcourse the individual has a preference!!).

    Sorry to rant on, I am quite a happy person (sometimes!!!)

    Lots of hugs to you all

    Serenity xxxx

  • yes serenity is right

    i was defo alarmed by what gp had told her!!!!

    way OTT....

    glad she sought more advice and help :)

    hope ur son is better too serenity :)

    x x x

  • 1 puff = 100micrograms X 25 = 2.5mg nebulised

    Confirmed by G.P. who basically said I could use as much as needed within reason & shakes permitting

    *Edited to add as much inhaler not nebuliser & yes I was surprised but Ventolin inhaler is 100 micrograms

  • ' 1 puff = 100micrograms X 25 = 2.5mg nebulised

    Confirmed by G.P. who basically said I could use as much as needed within reason & shakes permitting '

    - that would mean 50 puffs is the same as a my 5mg nebs!!!?!?!?! omg lol

  • So somewhere between 10 - 50 puffs is equal to a neb... :S

    Permission to be confused, please. :(

    I'm really struggling today - needing 10 puffs through spacer every 2 hours plus if I try to do ANYTHING - shower, cook, walk to the post-box (a whole 3 minutes flat walk... :( ), consultant says 'oh well...' (huh?), A&E give me nebs and send me home telling me to use regular nebs at home even though I tell them I don't have them, I really don't know what to do. Fantastic asthma nurse was supposed to be in when I went to see them last week, but when I asked where she was, stroppy nurse justs says 'she's not here' (huh, you don't say - even I figured that one out), fantastic GP who really understands me and my asthma is away for 3 weeks, feeling really confused, really unsure and quite frankly, not very safe.

    Sorry, just needed to rant, I don't know what to do, and I don't have anyone to ask. I'm very tempted to go to the GPs on Monday morning and insist they do something but it'll be a locum who doesn't understand my asthma and I don't want to come across as difficult.

  • am also struggling ratty.... needing 10 puffs via spacer 3hourly earlier, last at 10, yet its only 1hr 40 mins and am wheezy like steam train :S grrr....

    x

  • I am on a easyhaler thats a powder one and does not fit a spacer. Its a 200mg and take ten to twelve puffs at a time 4 hourly. Asthma nurse was happy with how i use it and i like the counter on it. At the moment can work it ok even how i am at the moment .Love glynis xxx

  • Ratty, there is other Ventolin inhalers as well as the standard MDI 100/puff, is that what you've got? G.P. did suggest could have 200/puff accuhaler ?easyhaler as Glynis said too if needed, think it may come in several other forms.

    (Edited *Great washing up idea, Howie, I usually cheat and use dishwasher but still droppage risk* D'oh wrong post reply)

    Hope you're feeling better and get to see someone useful soon.

  • I have an asthma nurse that is very pragmatic and doesn't quite agree with my consultant so I am very lucky to be getting the best of both worlds. Consultants don't want me nebbing as apparently it makes you so much more brittle and prone to respiratory arrest but asthma nurse appreciates that I am sensible and don't actually have a death wish and so she told me to buy a nebuliser and prescribes the nebs for me (as much as I want) because as she explained, yes inhaler+spacer=same as neb but the nebuliser drives the medication down your airways for you without as much effort on your part.

    My advice to anyone that is struggling to multi-dose as I was 18months ago is to get the asthma nurse at you GP clinic onside to prescribe you nebules. I did this by complying with anything she asked of me basically and now how so much more control of my own asthma, I even have pred on repeat now so I can start it whilst I wait for an appointment with her as I aired my concerns that seeing anyone else at the surgery was pointless!

  • Nickynoo,

    Glad you have a understanding asthma nurse as it makes things a little bit easier to deal with. Our surgery are very good, always get seen no matter what and on the note of pred, we too have pred on repeat for Louis, as as you have said its great to have on standby before you actually get seen (I feel soooooooo much better knowing we always have pred in medicine cupboard!!)

    Serenity xx

  • NickyNoo, your asthma nurse sounds great and really understanding of the problem. I might have to come steal her!

    It's really difficult, and I'm getting fed up of trying to explain that multiple doses + Volumatic ain't doing it for me and getting 'the speech' - and then the A&E docs send me home and tell me I need regular nebs when I tell them I don't have home nebs - ggrr!!

  • Ratty, I have just seen this post of yours. I can totally relate to what you are saying about the ten puffs through the volumatic not being anything like a neb! I have tried explaining it to my GP & con. They just dont get it! I find it very tiring to use the inhaler & ten puffs when to sit with a mask on & a nebuliser doing all the work is such a relief! You have to have alot of strength to do the ten puffs thing & then I dont feel its worked but a neb just hits the right spot! I wish the Drs could try it & see where we are coming from! I dont know what the answer is, sorry. I just wanted you to know I can relate to this & I'm glad I'm not the only one who finds this. Take care, thinking of you.

    S.Mama

    xxxxx

  • Grrrr, just seen a locum GP after a really bad night, got the whole 10 puffs = neb speech from her. Now have antibiotics, even more smarties and been told to take 10 puffs every 2 hours... :o

  • Ratty aww ! Not nice having chest infections on top. Hope antibs and smarties kick in soon for you. Nellie got a lot to answer for xxx

  • Agree with Shoppingmama - reliever via spacer is hard work when one feels really poorly.

  • im sick of the every day struggle and fight with lungs on 60mg of the horrible white little tablets at min if its not one lung its the other or both sorry just not happy with lungs and the every day fight with them at min xxxxx

  • I think I am going to have to keep my asthma nurse a big secret! Her response to me was that it is her job to improve my quality of life and that seeing as I have a positive attitude then they will do everything they can. She totally gets the increased effort of using sapcer when you really need it.

    I don't mean this to sound bad of NHS staff as they are all great too but she is a Royal Naval nurse and so I think she has a slightly different attitude towards doing what is necessary and doing what is best.

    I have had great fortune with both my asthma nurse here and when I lived in Devon, can't say the same for GPs unfortunately

  • Symbicort as reliever

    Hi all. Just wondering if anyone uses symbicort as a reliever? I got told by my asthma nurse to use that rather than ventolin.

  • Re: symbicort as a reliever

    Yes, I do.

  • Re symbicort as a reliever

    I've also been told to use symbicort as a reliever, but since I've been using it I've not had too many problems so I can't really say how well it works - but it's only a matter of time ..........

  • As my asthma's behaving at the moment (don't make them the famous last words...) and my regular GP is back from wherever she's been sunbathing (don't GPs know they're not allowed to go on holiday!?) I decided to talk to her about this. Now I was expecting the whole 10 puffs with a spacer exactly the same argument, but actually she agreed with me that a neb would be more helpful, especially as I have dexterity and co-ordination probs due to other conditions.

    Problem is, she looked it up on her magic computer and said she couldn'prescribebe it on the NHS. Now I assume she's referring to the actual nebuliser rather than the nebules? She's said that I need to talk to my consultant about him prescribing it, trouble is, I know he's just going to give me the 10 puffs and a spacer argument as he only sees the asthma and doesn't comprehend the issues of my other conditions or even living situation (takes me an hour to get to GP on the bus for a neb, hence GP saying would be more sensible to manage this at home, which I agree).

    So now I have my GP, A&E docs, asthma nurse at surgery and my neighbour who I like to scare (who's a nurse) all saying home nebs should be considered, it's something I want to try, but how do I get my consultant to understand?

  • I was told by my consultant that they don't prescribe nebulisers anymore, even when they want you to have one. They used to loan them from the hospital but i had to do research and find one that seemed like it would work for me and buy it! I have since seen that many people used ebay quite successfully. I got mine direct from Clement Clarke though. you do get VAT excemption.

    Sorry to be the bearer of bad news, hope someone else will say that it is just Southampton General that are scrooges!

  • hi ratty

    it could possibly be that it is your co ordination with inhaler and spacer. I know i had great difficulty getting the whole press breathe out, breathe in thing. I also then hit the problem of i cannot have the inhalers you have with the spacers due to ingredients and an accuhaler in an attack does not work.

    They do not like you having nebuilsers at home because once you do you just cannot get off them! Trust me i know! Also you end up staying at home far too long when you really should be in hospital. If you are needing to go to GP often for nebuilser something is not right with your asthma. You do not sound like you are controlled. i think this issue should be brought up with your consultant as priority. Tell him you are needing to go to GP reguarly for nebuilsers and can he increase your preventer or steriods to get you better asthma control.

    I wish there was a reliever inhaler i could have and carry around with me so i did not need to carry a nebuilser every where it is a nightmare in itself and the comments that go with.....

    I would question your consultant about controll because you are needing to go to GP to get nebuilsers.

    Plumie

  • Thanks Plumie - it's not an ongoing problem, but a problem when I'm unwell, for instance with a chest infection. At the moment I'm okay (apart from the smog...) so don't need the 10 puffs + spacer, so it's not an issue. Last time I saw my consultant he said there wasn't anything else he could do - really helpful and understanding, I think not.

    Co-ordination isn't so much of a problem, but I have limited use of one hand and get a really painful arm having to hold anything (such as the spacer) which was another reason the GP and I talked about nebs as a possible other option for home use.

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