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One 2.5 neb is = to how many puffs of ventolin?

I used to know but my brain is befuddled. Can anyone remind me how many puffs of standard inhaler a 2.5mg neb is = to.

Bex

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10, allegedly. Although this doesn't ""add up"" in doseage terms (1 puff = 100mcg), it's down to delivery - there's a lot more ""wasteage"" with nebs. Apparently.

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Thanks Cath, that is what I said but eldest son said it was more. Mum is always right :)

Bex

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In that case, I'll pose a follow-up question for Dr Cath ;) ...

If there's more wastage with nebs, why not just take 10 puffs of an inhaler through a spacer?

This is a question that I feel I should know the answer to but can't for the life of me remember it.

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It is now recommended that 10 puffs through a spacer is used as first line treatment. If you are more unwell, and need oxygen, or are struggling to coordinate the spacer then a neb is more helpful. I find the spacer option is fine unless I am really struggling, when it takes all my puff to concentrate on breathing rather than on puffing away at the inhaler - a neb is less effort to use.

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I was told last year at Rbh that 10 puffs via spacer is just as good if not better than a neb.... makes me wonder why everytime they admit Sean they give him hourly nebs if they really belevie that.

On the other hand in my local last year a doc tried the same, he was giving Sean 10puffs ventolin hourly, another doc discharged and said he must be ok cos he not needing nebs... we went home and i carried on nebbing him. Sean says a neb works much better for him so they can keep there inhaler and spacer :-)

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Thanks for the response, Owl.

As another follow-up (and this is something Cathy and I were talking about last night), if the main reason for using a nebuliser is that it's easier to deal with than an MDI through a spacer during an acute attack, why use a neb as part of daily treatment?

In the case of a friend of ours - who is on daily Flixotide nebs - she could theoretically get the same level of medication through 4 blisters of the highest dose Flixotide inhaler; and this would take less time to take than the time it takes to nebulise.

Am curious, since neither Cathy nor myself could come up with a convincing reason!

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Flixotide nebs

I have also been prescribed flixotide nebs in the past.

Originally they were prescribed for me in the days when I had taken short courses of prednisolone as a step down treatment for a few weeks until I returned to the flixotide inhaler.

Now, I take more regular courses of prednisolone - flixotide nebs are still prescribed. I did ask why this is used instead of the inhaler and was told that some people benefit more from using the flixotide nebs than the inhalers - no particular reason given, but if it helped then it was worth it.

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I appreciate what all the literature says and research. However i agree that nebs are easier than spacer and inhaler. Esp during an attack u haven't got the energy to use spacer and inhaler like owl says. Neb is 'hands free' if ure using a mask and doesn't require effort. I also combine salb and atrovent nebs when unwell so makes sense.

Obv also if ure using an o2 driven neb u can't do that with a spacer!

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Hi,

one of my consultants did a study looking at nebulised steroids compared with normal inhaled ones and found that there was no improvement with nebs. I must admit I never found the nebbed ones useful when I had them years ago - just a hassle.

Also as you say you can use more than one drug together via neb if unwell - which is useful.

Not sure why some people are on nebs rather than inhalers for routine use, although their placebo effect is much greater - not suggesting that is the reason foe anyone particular so please don't get upset. We used to see a lot of lol with copd who had got a neb off the back of a lorry in Lanarkshire, who thought it was the best thing since sliced bread despite making no difference to lung function.

I guess that whatever works for the individual is important too - so if you find 10 puffs via spacer as effective as a neb then you could use it instead.

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Lol owl like ure copd pt story!!! I have to agree that i find nebs a complete hassle and time consuming esp when busy, didn't say my last post was relating to acute situations. Unless i'm unwell i carry a good ole mdi salbutamol! However, when i'm unwell i neb.

Interesting research ure consultant did owl.

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could this be a reason why my local costa tend to have a no discharge on nebs for home use policy? asked if i could have nebs at home just while struggling bit as using 4 puffs ventolin today every 2-21/2 hrs for chest after making quick escape yesterday after being on 5ml salbutamol nebs every 4 hrs after being admitted thorugh a and e on monday. would i be as well to use 10 puffs in spacer less frequently i wonder. anyone any thoughts?

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Katharine,

I would try it and see. It seems from what people have posted different things work for different people.

I was told that I could do this with my salamol inhaler when I am unwell. I felt that it worked for me and stopped me needing to go for more nebs. Previously I'd been having to go to the Dr's and A and E to get nebs to feel better each day I'd been unwell. This time I only needed the one and taking 8 puffs of the salamol inhaler every 3 or 4 hours really helped.

Beth

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I was told 12 puff.

Well at least that what dose I got given when the paediatric ward treated me with spacer/mdi (it was 12 puffs ventolin / 4 puffs atrovent) .

side not-- I get more relief with nebs, even between exacerbation when I have pre and post bronchodilator pfts done I always have a greater increase post with nebs compared to inhaler.

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Katherine, the reason your hospital has a no neb policy for asthmatics is because asthmatics go off more quickly than copd patients so need attention quickly and the school of thought is that if you have a neb at home you will sit at home longer. Those on here who have home nebs have strict guidelines aswell as experience with our lungs of how far to go at home before going to hosp. Its a pain going to a and e all the time for nebs put its not done without reason, that way you can be carefully monitored. But if cons is happy and feels needed it can be done thats where i got mine from but not without a fight from bice cons and strict instructions to follow.

love Andrea xxx

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Just to second what andrea said. I was on oxygen fulltime before I was given a home neb. In paediatrics at my local hospital my consultant was very against home nebs, he'd seen how bad I was when I went in and said if I sat that out at home on a neb it would not be safe. They have no paediatric critical care beds at my hospital and so he didn't like the thought of me sitting it out and getting worse at home when the nearest paediatric critical care bed is over 40 minutes away at the children's hospital. When I crossed over to adults, my adult consultant who deals with alot of COPD patients was very happy for me to have a home neb, his reasoning was I know me better than anybody else. I have not yet made any massive mistakes and know after a couple of breaths on a neb which way its going to go. I would guess it depends alot on the consultant and how unwell you are when you splat.

Tks xxxx

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I've been told that a standard ventolin/salb MDI dose is 2 puffs or 180mcg. The nebuliser 2.5mg is 10 times greater.

However neither method of delivery takes into account the amount of medication that actually reaches the airways. Factors such as state of breathing, inhaler technique and even the propellant used in inhalers these days – HFC’s – notoriously drying ‘cause they are alcohol based, which can cause bronchospasm etc etc, - all affect and have an effect upon relief of symptoms.

Mia

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