Nebuliser protocols

Hi Everyone,

I've just been catching up on the posts and there are quite a few about nebs at the mo and it got me thinking, so decided i would ask you very knowlegable people. I have just been discharged after 15 days in hospital, which is my longest time in, i know thats not a long time for lots on here but its really knocked my confidence.

Prior to this admission my nebuliser, which was given to me by my con at local hospital, was meant for emergency type situations when inhalers not effective to give additional relief. I was allowed 2 nebs and if not responding had to go to A and E, also had to take pf before and after if no improvement also had to go to A and E. However have been sent home from hospital, they told me to use it more regularly, whenever i felt the need, which at the moment is 2-3 times a day (the hosp. say this is ok). However they didn't update or discuss my protocol before discharge so now i'm a bit confused as i no longer know when i'm using it too much or when to go to hosp. As I said before this admission knowcked me confidence wise and i didn't get to see my usual con as he was on holiday (typical!), and i'm really scared and unsure, still feel i'm struggling but now not sure when to call it a day, don't want to go in and have them say i could just have continued to neb at home but equally don't want to leave it too late either.

Any advice greatfully received




7 Replies

  • Libby, if you are worried or not happy then get yourself into costa, no matter if you could tecnhnically still neb at home cos the worry will only make things worse. See if you can get an appt to see your cons as soon as he is back or call him and explain you are worried. I am sorry you have had the stuffing knocked out of you. I am reeling a bit from splatting big time whilst in RBH on IV amino and mag sulphate, hydro cort and potassium not to mention the good old sub cut, I can't for the life of me work out how you can splatt through all that and so suddenly.

    I am really worried about coping at home but I know they won't let me go until they are happy I will cope and for once in my life I will not be screaming and shouting to be let go just a bit sooner.


  • Hi Libby, if i were you i would stick with your old protocol for now until you see your cons, 2 nebs at home should be enough to see if things are improving. as said before if you are not happy go to a+e, it is better to be sent home caus you are ok than sit at home frightened.

    love George xx

  • Hi Libby,

    Sorry to hear about your setback, and loss of confidence. Like everyone else has said you need to go back to the hospital if you are feeling worried and/ or can’t cope.

    Stay with your current protocol for now and if that’s not working go back into hospital. Don’t rely on medics who don’t know you or your condition properly re using extra nebs at home.

    I once overused my old neb in the past, because of not wanting to go back into hospital, having just been let out. That mistake nearly cost me my life. I had a protocol arranged with then chest con, re number of nebs and symptoms, but thought that by using a couple more nebs at home it would be the same as going back to A&E, where I rather arrogantly assumed the same treatment would be given. It took a long time to get me back to breathing on my own and without the use of oxygen. It took months until I felt anywhere near normal. The cumulative effects are much worse, and more far reaching than the actual acute stages, --awful though they are – if left untreated.

    If you are ‘scared and unsure and struggling’ please get help.

    Lots of love to you.



  • Libby I felt exactly the same recently.

    I used to have nebs for emergency use and now am nebbing daily which I never used to have to do. I have been told diff things...A&E dr few wks ago said 2 me neb 2hrly then wean down 2 3hrly, 4hrly etc over a period of days. My consult says 'when you need to.' Don't you just love that comment! I'm seeing him 2moz and want a protocol as he also said to come in (costa) when I know I need to.....when the hell is that!!!

    I confess that I have taken protocol into my own hands a bit. I tend to neb when I can start to feel myself at the early stage of a splat/being quite symptomatic and usually manage to fend it off. However, I find when I neb regularly throughout the day I tend to be a lot less symptomatic...preventative medicine as one dr said 2 me. My bf is a big fan of the latter and gets annoyed if I could ave nebbed to avoid getting worse and leaving it too late.

    I suppose in a way I worry about relyin on nebs too much but am v pleased as they reduce my costa visit frequency which was getting far too regular recently. I feel now that my chest only responds to nebs not plain old inhaler :(

    Hope that rambling makes sense. If in doubt go back 2 costa and stick to what you feel is safe and ure happy with.

    Take care,

    Em xx

  • Protocols and all that....

    Hi all,

    Felt like I had to post this info as I used to be one of the worst for ignoring this type of medical advice...

    Not preaching and all that just trying to help...

    Nebuliser drugs like salbutamol and terbutaline work upon the relaxation of the bronchial smooth muscle and widening of the airways And yes these drugs will always play a crucial role in first post opening of the large airways. But they do not in themselves work upon the alleviation of the inflammatory process which just carries on, regardless of the use of nebs, spacers, MDI and DPI reliever -either combined or single drug combinations.

    Here’s some info I’ve copied and pasted from the British Lung Foundation site: -

    Nebulisers give a much higher dose than a puffer or a dry powder inhaler. Do not use more reliever (eg. salbutamol) than you have been prescribed. If you are feeling more than typically breathless, and your usual dose is not giving the relief that you normally expect, it could be that your tight chest is the early warning sign telling you to get in contact with your doctor. Taking extra doses of nebulised relievers will only disguise and delay the need to seek medical advice, even if a higher does seems very necessary to you.

    Tip of the iceberg and all that?

    It’s so easy to either use more long acting reliever drugs like formoterol and salmeterol and/or/as well as short term reliever drugs such as salbutamol and terbutaline.

    Even the anticholinergic inhaler/ nebulised drugs such as the antimuscarinic bronchodilators, examples include atrovent and ipratropium bromide, only work to relax the muscles around the airways.

    If you are continuing to experience asthma symptoms like wheeziness, tight chest and breathlessness and you have reached the limit of your reliever type drugs as prescribed and advised, it’s time to get a reassessment of your asthma, and what is going on underneath the tip of the iceberg.



  • Mia...excellent info. Thanks. I think we all have to remember (no preaching intended) that we all have our own protocols and can't go on each other's. Every1s asthma is different but if in doubt costa is there for our wellbeing!!

    LIbby...I really hope you feel better soon. Keep us posted.

    Em xx

  • Thank You


    Thank you for all the replies. I went to see y GP today for a bit of advice, told him i felt unsure about when i was nebbing too much and what was acceptable. He said that he felt it was acceptable to neb uo to 4 times a day, if I find I'm needing more than that I must go and see him and should probably be in hospital. He also said if i neb and its not effective, I can try up to 2 nebs then must go in. I feel lots happier that I have some sort of guidelines to go by, makes me feel a bit more secure. I'm seeing my con on the 19th July, so GP said to make sure i get a proper protocol sorted then. I really hope I gain more stability before then though, as GP pointed out today theres not a lot he can do, except offer me a bed back in costa.(Great!, no thanks!)

    Mia - thanks for the advice, totally agree about being careful and not becoming too dependant, thats part of the reason i was so worried that i didn't have any guidelines set down. My cons have been working for a while now trying to figure out the cause of me being so unstable, yet to find an answer though. I'm on top whack of most drugs, so until I see con and see what bright ideas he has up his sleave, my only options are increased Pred (already on 40mg at the mo) and more reliever drugs eg. nebs. I'm really hoping they can find a reason so more control can be gained! Thank you xxx

    Emily - Thanks, its comforting in a way to know you're not the only one in this situation, if you know what I mean. It does get a bit confusing with different docs saying different things doesn't it. Hope you cons appoinment went well and you manage to get a protocol sorted. Take care xxx

    Thanks once again everyone



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