Multiple Puffs

A question occurred to me today when I had to use 10 puffs of Ventolin in my Volumatic as a neb equivalent (seeing GP first thing Monday - I'm fine now, asthma just doesn't like this weather and I've been unwell with other stuff recently).

I'm sure I read somewhere on this site that when taking regular meds through spacer (i.e. my steroid inhaler), I have to do the two puffs separately with time between so that the second puff is medication rather than just propellant.

So why, if I'm told to put 10 puffs in the large volume spacer is this OK and the last 9 puffs aren't propellant?

Does that make sense?

10 Replies

  • It's not just propellant for the remaining 9 puffs, but my understanding is that you have to do each puff seperate so that the lungs can absorb what is inhaled, but I do agree with you regarding regular medication. What is the difference between say 2 puffs of steroid at 250mg in one go via a spacer than 1 puff of 500mg dose?

    This doesan't answer your question, but someone must have an answer that makes sense why you can do it for somethings some times but not others.

  • They reckon you should do 1 puff - 5 breaths, take the inhaler out, shake and repeat. As you say it's something to do with mixing the solution up inside!

  • a sort of answer to your question - an a personal story ( CONTAINS ISSUES OF BULLYING )

    ratty ,

    i dont no the exact answer to your question but , i guess from the experience i had that yes the other nine are a lot weaker than the first as they contain more propellant ,as elephant said i would shake before each puff ! this is the way in which i do it with my brown inhaler (although i use an aerochamber rather than a spacer nowdays .) i think what woody said was right it depends on what the meds are to the rules - dosent make sense really

    from personal experience :- a good 7 years ago now (when i was a lil bit younger) i had problems with usisng my inhaler with out the volumatic and it just wasn't working effectively so they switched me to an turbohaler instaed for my reliver and it helped me dramatically because once you have turned you can work at your own pace and he told me i could take it repetetively . another reason they agreed changed me to the turbohaler was about a two years after i started secondary school . in the first year in secondary school i continued to use my inhaler with the spacer but had terrible problems with having to always carry it around with e everywhere in school as well as the overload of books you are given when you first start , i gradually adapted within a few weeks to the way the timetable worked which meant i could carry the volumatic around easier ! but then came the horrible teasing adn sarcastic remarks from other kids who started to make my life hell , teachers were understanding but i didnt stop so i went to the doctors and asked for a way of getting round using the volumatic , they suggested just using the inhaler on its own , so i tryed it , it didn't work atall as i was just getting so little medicine and more propellant and also i couldnt get the timing right , needless to say the bullying stopped though.

    third year at secondary school - it eventually got to the point where my asthma was spiralling out of control and then the bullying started up again as i couldn't cope with physical education lessons or even the school stairs which made me miserable as even the kids who had special need (no disrespect they are lovely) could do more than me and this started up the teesing. so i went to see my asthma nurse who was disgusted at what had happened and she got my doc to come in an listen , they both eventuallly agreed i had gone through enough. an i was given a turbohaler to repalce my old reliver and a aerochamber for use with my preventer.

    and i can say it was so much better afterwards , i'm now at college and am fighting back - i might not have the best health but i have learnt that i will always be better than them if thats what they got there kicks out of ! an as for my friends i couldn't have wished for better support .

    basically ratty after expalining my story what im trying to say is go to your doc if you are unsure of having problems they will be able to help , and there might be a simple alternative you can push for - don't wait untill its to late like i did pleasse !

    lil tinx xxx

    p.s. sorry to get all personal , and rant on forever in a long post , but it feels good to get it out and no that my sorry might help someone else.

    one last note to anyone reading this : don't wait till its to late ! xx

  • Thanks everyone for sharing your info/understandings/experiences. Lil Tinx, I had similar experience at school, I was bullied for other reasons too (definitely doesn't excuse it) and that just added something else - unfortunately I got it from the teachers as well as the kids.

    I'm going to ask my GP tomorrow for some clarification because she told me to put the ten puffs in together and I've never questioned this. I'm desperate to do anything to keep me well and out of hospital. I find the way I'm doing it does work (and if it doesn't I know immediately I need help) but it would be worth knowing if there's a more effective way.

    As to dosage, I've never understood why we take two puffs rather than them just give us a double strength inhaler other than for people managing their own step up/down programmes for their meds and who need the flexibility to make adjustments?

  • thats ok ratty , i has kind of helped me to tell the tale , im sorry to hear you had a similar experience , i had a really nasty pe teacher in my first year of ssecondary school , who told me she thought i was being lazy and to stop faking my problems , that i was being a waste of time - im afraid to say some people just dont understand.

    hope it goes ok with your gp let me no how you get on i would be intrested to know , and you can always p.m. me anytime if you want to chat ! im usually intouch with the computer most days !

    lauren x

  • I asked my GP about the multiple puffs thing this evening, and he said normal preventer meds are to be done singularly for a reason.

    Now if you have a LABA and separate steroid inhalers, you are recommended to take the LABA first, then wait a few mins before the steroids, thats so the airways are opened up first. If however you have a combination inhaler, the reason for the separate dosing is that the time gap of a minute is to allow the airways to open a little more and so the second puff goes deeper into the lungs.

    As for the large dose of ventolin in the first post, thats a separate issue and is to give a maximum effect as a recovery measure, and not usual daily practice.

    hope this clears things a little,or perhaps confuses the situation.


  • This is what I was told

    After my second stint in A&E, the doc there told me I can give myself neb sized doses of Ventolin to try to get a severe attack under control. This was the procedure:

    1 puff in spacer, breathe steadily 10 times, shake and repeat, up to 12 times. This is equivalent to 1 nebuliser dose.

    Wait 5 mins and if no improvement, the whole procedure can be repeated once more, and if still not under control, call 999 or go to A&E.

    Was told to expect shakes and high heartrate, and told to ALWAYS follow up self-medicating like this with a GP visit within 48 hours.

    I've had one incidence where 12 puffs did the trick, but last time when I got to 17, I realised I needed help. Went to A&E, and they gave me a re-breathing mask, as I was panicking and hyperventilating, and monitored O2 levels until I calmed down. I had pretty much controlled it by myself, so didn't need a neb. They also gave me a mask to take away.

    I now feel much more confident in managing a severe attack.

    Hope this helps.

  • I can't believe how different the information being given is and this doesn't seem to be based on what's right for an individual but simply different information.

    I had a med review with my GP yesterday so we went through all the meds, had to demonstrate technique (again!) etc so it was a good chance to talk spacers. One confusion was that we were talking about different spacers (I use the Volumatic with Ventolin as a neb and the Aerochamber for my steroid and LABD) and it seems to depend on the valve they are fitted with :S

    Anyway, I was told with the Volumatic as neb the same as elephant has below - 1 puff, 5 breaths, shake (inhaler not self :p) and repeat up to 10 times.

    Previously by consultant and pharmacist who did med review recently I've been told with everyday meds and Aerochamber it's just 1 long slow breath in - the spacer just means the meds get deeper into your lungs rather than hitting the back of your throat. I was also told that the order of LABD and steroid inhalers didn't matter because the LABD effect isn't instant enough and it is 'long-acting' so should still be acting provided it is taken regularly. To confuse matters nicely, I take two LABDs and a steroid inhaler in a LABD - Steroid - LABD pattern, simply because the first two require the Aerochamber and the third doesn't :S

  • I use a volumatic myself, and the instructions that came with had two methods of using,

    1 was to take a single deep breath for each puff from the inhaler, or the 2nd you could use 5 smaller in-breaths per puff from the inhaler, and it was down to what you feel comfortable with, and to some extent the ability to get one really deep breath.

    I use it for my seretide, and recently for the ventolin before a run now, and get better result for the ventolin.

  • *bump* for Learnermum

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