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Hey all

Ive been reading heaps of posts about nebulisers and found that most people with nebulisers have a protocol. I dont know if its different in Australia but my doctor was like just use it 4 hourly as needed (same a ventolin inhaler). so im a little confused am i ment to use it insted of my ventolin inhaler (btw i have 5ml salbutamol nebules) or as well as (like if my inhaler doesnt give me my normal relief). At the moment I use my normal inahler 6-12 times (as perscribed) and if this doesnt give me normal relief or if my symptoms come back before 3 hours then i will have a neb (or if my symptoms are really bad). If a neb doesnt fix it ill go to the Dr. or emergency. Do i need a neb protocol??

hope all are well


2 Replies

Hello Kate!

I would get a written protocol from your doctor on using a nebuliser and stick to it!!

From what you are saying, you seem to be doing the right thing, trying inhaler first then neb and then if neb don't work, getting emergency help.

It is important not to get too reliant on home nebs because often by the time the nebs are not working your asthma can be severe and you should be in hospital.

I have a written protocol for all my asthma meds which I keep up to date myself.

For me, If two nebs don't work or I am going off very quickly a I am calling 999 (emergency no. in the UK)

There is no harm in having things written down - it can be very helpfull in an emergency just to hand over a sheet of paper with all your usual med on, what works best in an emergency allergies etc.

Also worth getting is a medic-alert bracelet medicalert.co.uk a UK based charity but I think they work world wide. Has brief details of medical condition etched on it and an emergency phone number.

Hope this helps



Hi Kate,

Yes, you should definitely have a protocol - as Kate Moss says, the danger is that you can get too reliant on your neb and get into a false sense of security about your asthma because you are getting some response to nebs, whereas in fact you should be getting yourself to hospital. In a severe attack, nebs will often not work alone, and other treatments like IV hydrocortisone, IV magnesium and IV aminophylline may be needed, or even, in an extreme case, intubation and mechanical ventilation. By the time someone gets to the stage where nebs aren't working, they are usually extremely unwell and need to be in hospital very quickly. The large majority of asthmatics, if they are ill enough to need nebs, should be in hospital. It is a very small minority of asthmatics who will benefit from and be safe to use home nebs.

Generally in the UK, most people only have home nebs after extensive discussion and assessment by a respiratory consultant, and with strict supervision and guidelines. It does sometimes still happen that people will be given a home neb without these things, but it is becoming less common as people are becoming more aware of the risks of this.

There are usually two main reasons why someone would be given a nebuliser at home:

1) If someone has attacks that are so sudden onset and severe that they need to be able to use a neb while they are waiting for the ambulance - this is very rarely the case as the vast majority of people will get as much benefit from 10 - 15 puffs of salbutamol inhaler via a spacer. If someone has a neb for this reason, they should only use it when they have called an ambulance and are waiting for it to take them to hospital, and their GP should keep a close eye on how many nebs they are getting through to make sure of this.

2) Occasionally, someone with very severe asthma who is already on pretty much maximal other treatment will find that they respond so poorly to inhalers that the only way of keeping their airways open is to use nebs fairly regularly. In order that they are not in hospital all the time, for quality of life reasons, they may be given a neb to use regularly at home. This usually happens after many hospital admissions for asthma, and after attempts whilst in hospital to get the patient off regular nebs by adding in other medication. No-one should have a neb for this reason unless they have exhausted all other treatment options without success. There is some risk inherent in this strategy, and many of us who are in this situation will have experienced attacks when they have not sought help in a timely fashion because they have a home neb. The risk has to be balanced against the quality of life issues if the patient does not have a neb at home.

In my case, for example, I was initially given a home neb for the first reason, because of my sudden onset attacks. It was only after a few years of being in and out of hospital and after being tried on pretty much every form of treatment that I was allowed to use the neb at home on a regular basis. Of course, everyone is different, and it is really up to you and your doctor to come up with a safe, workable strategy for you. The important thing is that you do have a strategy, though, and that you know when it is safe for you to be using the neb at home and when you should be getting yourself to hospital. In general, you should err on the side of caution, and if in doubt, call an ambulance.

Do discuss it with your doctor so that you are doing the right thing, and you may want to ask if there are other treatments that you can be tried on before you go down the route of being on regular home nebs.

Hope this helps

Em H


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