Emergency Dr's and nebulisers

At the weekend my friends husband had a bad attack, she's only known him 2 yrs but apparently has never seen him that bad. Anyway, she rang the emergency dr's and told them she thought he needed a nubuliser. When she spoke to the dr he told her that they don't use nebulisers anymore but prefer to use stronger drugs with spacers as they think a nubuliser doesn't get to the places where they want it to go. Sounds a bit odd to me, i've never had a bad attack, had a nebuliser once at emergency dr (different area) but has anyone come across this before? I should point out that he was adament that he didn't need an ambulance (which is what my friend wanted to do)

I would have thought that a nebuliser was a very good thing to use in the case of a bad attack?


17 Replies

  • i've heard this too but in my non medical (but as a mum of 3 asthmatics and being asthmatic myself) opinion a nebuliser not only works but also helps you to calm down. it also takes away the effort of brathing in which is required with the spacer. you can even give it to a child asleep as i have on many occassions when my youngest was a toddler.

  • I agree with debi

    Nebs definatly take away the panic effect of an atttack so breathing becomes less of a effort. (well it does for me!)

  • Speechless here reading that...

    Sorry to pontificate, but I speak as a chronic severe asthmatic who wouldn't leave the house without a neb on board, not even to drive as far as the postbox and back.

    To make some points before I self combust with my speechlessness!

    Please clarify if the 'he' is your friend's hubbie or the GP talking in your sentence, and I quote ""he was adamant that he didn't need an ambulance"".

    Any Doc saying that should be struck off, and no I'm not joking.

    Just glancing through these threads will let you and your friend and that 'Doctor' hear how quickly a lot of severe asthmatics 'go off'. We could be gasping but still 'with it' one minute, flat out cold and in need of ITU the next.

    There is a thread that has been running in the past few days on the merits of multiple puffs in a spacer versus using a nebuliser. Worth having a read of that and showing the different ideas to your friend and that 'Doctor'.

    Thank God I have never been attended at home, or in A&E by an emergency Doctor without a neb. I for one, like countless others here would be pushing up more than daisies if that really was the case.

    I have had Nurses/Doctors not quite know how to use a neb before, but have never heard of them favouring spacers and multiple puffs over nebs in such an emergency siutation as your friend's husband just had.

    I would also love to know what this 'stronger drug' used in the spacer would be?

    We all have just plain old Ventolin inhalers )or maybe the odd Bricanyl MDI still in circulation). Lord only knows what a stronger version of one of those is. Again I think the Doc is misinforming here as 'stronger' can only mean more puffs into the spacer.

    I apolgise for such a ranting reply to your innocent post, Moose 1, but I am quite terrified of that ever happening to me, if this Doctor is ever circulating as a Locum in my area, heaven help his ideas!

    Did your friend get his name???

    Sus xx

  • Hi Christine,

    As everyone has already said I too have not experienced the spacer is better than a neb argument during an emergency exacerbation of asthma. The usual first post or stage of treatment is, or should always be, the use of a nebuliser, if prescribed medication is not working

    If it was your friend's husband that made the comment, 'didn't need an ambulance' (you didn't make that point clear) then yes I can truly understand the lack of awareness re how bad an attack can be. In the past I have also 'turned back' ambulances thinking I could get myself into hospital and not wanting to bother anyone, (says she blushing furiously). Always backfired though. Lack of oxygen equals irrational thought!

    However if it was the doc saying your friend's husband didn't need an ambulance then I too am speechless.

    Perhaps you could tell your friend and her husband about AUK. Sounds as if they would both benefit from reading about the 'inns' and outs of other folks' experiences.



  • hi,

    I'm glad i'm not the only 1 surprised by lack of nebuliser. I will just clear up that it was my friend's husband that didn't want the ambulance, not the doctor. Her husband is 1 stubben man! I don't know what these stronger drugs were, i did ask my friend but she didn't know but i suspect the doctor probably meant more puffs of the reliever.

    Don't apolygise sus, it must be a very scary thought to someone like your self as a sereve asthmatic.

    I wonder if part of the problem is that every doctor has a different way of dealing with asthma, there doesn't seem to be a unified way of dealing it?


  • I want a nebuliser

    I myself paid a visit to the A&E only yesterday and was put on a nebuliser. Do you know if there is anyway in which these can be purchased for home use?


  • yeh you can buy them for home use

    if you want a good website for them pm me and i wil gove you the url



  • Hello Wine lover,

    Nebulisers are usually only recomended for home use if you have been prescribed them by a doctor or consultant. It is fairly easy to purchase a machine but then you will need the medication which the doctor would be reluctant to precribe to you. They are for emergency use in most cases or for some of us here who have severe asthma daily use.

    Doctors won't give you the meds if you are fairly well controlled and have the occasional flare up - it is much better to either see your GP or go to A&E.

    Nebulisers in inexperienced hands can be dangerous because you may just rely on it and over use it when you really need hospital treatment. They should not be used to avoid goingto A&E however inconvenient it is etc. In A&E they can monitor your condition too!

    It is better to look at other medication and preventers etc to control asthma first.

    Hope this helps.


  • i have my own neb and have strick instructions what i can neb then i must seek medical attention especially if i go camping something i enjoy but allergic to grass but still go can not let it stop me going big this in august camping with 100 kids lets hope i behave myself no more addmissions

  • traci i couldnt pm you back so i thought i would put it on here


    is the adress its about 10 mins away from me if you want i could post it to you if you life a long distance away

    hope this helps



  • Please do not waste your money randomly buying nebs unless it has been recommended by your chest/asthma cons. Most GP's will not prescibe the solution needed anyway unless it is by recommendation of a consultant. People could die sitting on nebulisers at home cos they don't realise how bad they are which is why they don't hand them out willy-nilly, there has to be a clinical need and a properly laid down protocol.

    Some of us have borught our own nebulsiers either cos the local authority will only provide one for a short time or becuase we want a small, quiet portable one but we all have agreed protocols with our consultants.


  • Nebulisers and acute asthma

    I work as a docotor in emergency medicine. The new guidelines issued by the british thoracic society (asthma specialists) recommend inhalers via a spacer and not nebuliser for practically all acute attacks except in very very few circumstances when a nebuliser should be used. I think the doctor was trying to explain this.

  • Just hope I never meet you in an emergency. Have tried spacers. Slow suffocation is about the only printable comment I can make re the use of spacers and uncontrollable asthma symptoms.… plus spacers are a lot cheaper than nebs.

  • BTS Guideline

    Craigm2 - as I have commented on a separate thread, the BTS guidelines are only meant to apply to mild and moderate asthma attacks, they make no recommendation on severe or life-threatening attacks due to absence of evidence.

    As most people on here can tell you, generating enough air-flow to move the valve on a spacer when having a severe attack is almost impossible.

    The guidelines are just that - guidelines - listening to the patient is just as important, if not more so. Most of us know our own conditions far better than our doctors could ever hope to.

    Em H

    PS I am a doctor too

  • If I was faced with a spacer in A&E, It may get flying lessons!

    Fortunately, I have a very good protocol so I usually get nebs & IVs!

    Em - thanks for clarifying the BTS guidelines.

    Craig - please remember every patient is different and patients don't always conform to the guidelines...... bit like babies - they never read the same manual as you did when pregnant! LOL

    Kate .... brittle asthmatic - have neb will travel ... & breathe!

  • My local cons is one of the top asthma and allergy Dr's and he is NOT behind spacers in an acute attack !!

    He says MOST people in the midst of a severe attack simply will be too exhausted to even use the spacer !!

    Even when my asthma was milder (I am a steroid dependent type 1 brittle asthmatic) I could NEVER use a spacer long enough to even take a normal dose as my chest muscles became tired very quickly like alot of asthmatics (or at least those i have met through over 14yrs of admissions to hossie) !!

    I am lucky in the fact my local A+E (15miles away actually aint that local to me) always get a warning of green men (para's) when I am en router now as I need Resus bed and senior team in place before I get there due to requiring a central line and aggressive treatment that junior Dr's just don't give me !!

    Another thing with emergency nebs is WHAT drug you use in it !!

    Give me Ventolin and I would quickly deteriate as it STOPPED working on me yrs ago and causes me to go OFF badly now !!

    I have to use ONLY BRICANYL nebs as I do every day (on top of oral Bricanyl tabs, long-term Betamethasone tabs and the other 20 odd meds I take) but you ask any emergency Dr or para IF they have Bricanyl available to use and the answer is a big fat NO !!

    I have to carry enough with me in amongst all the Anapens and steroid tabs and antihistamines etc etc I have to carry in case of emergency BECAUSE emergency Drs and para's simply dont carry Bricanyl (or the ones in Staffordshire dont) !!

    I carry 4x Anapens (easier to use as they have a button release where Epipens dont) at all times because:

    A) I now deteriate so quickly I quit breathing and arrest !!

    B) Have multiple severe anaphylactic allergies !!

    And when I deteriate I deteriate within seconds and even 10mg per neb of Bricanyl back-2-back does not help so I cant see how MOST of us (there are many on here for sure) would EVER be able to use a spacer !!

    The whole point of nebs is that they give a HIGHER dose more quickly and are not exactly prescribed willy nilly to people who dont need them !!

    Those of us WITH nebs can do well without well meaning Dr's (sorry EmilyH and others) telling us a spacer is just as efficient as a neb as from the PATIENTS point of view it could be a fatal mistake of am A+E Dr ignored the patient and didnt neb them but forced them to try a spacer !!

    Sorry but nebs are MAJORLY different from a patients point of view to a spacer and it makes me angry that people are forced to suffer because someone else thinks they know whats best for us when we have lived with this illness longer (certainly for me and our A+E Dr's) than they have even been qualified !!

  • Don't forget nebs also add moisture and a lot of us have thick gunky mucus which plugs during an attack and then the added moisture from the really helps clear it.


    (Type 2 brittle who alternates between up 10 puffs to of combivent through a spacer for little dips but also has home nebs for the really bad ones!)

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