Really dont understand this sometimes....
Yes, I can see how it makes people think they are better than they are because the neb is masking the symptons but they seem to assume everyone is stupid.
Must admit, based on how appalling our local hospital, going in to A&E just to get a nebuliser is never the best option!
My wife is a registered nurse so knows the score but they're still not keen to let her have a nebuliser at home!
yeah - most doctors will only let people have home nebulisers as a last resort. I know it is frustrating to have to go to A&E for a nebuliser, but it does put you in the safest possible place if things go downhill. People who do have home nebulisers tend to be either people who have such frequent symptoms that they rely on home nebulisers on an almost daily basis and therefore they would be completely unable to leave hospital for more than a few days, or those who deteriorate so quickly that they need to start a nebuliser before an ambulance can even get to them in order to make them as safe as possible.
I know how you feel, i think that personally I am in A&E far too frequently currently, and that based on how well i respond to prompt nebulisers when im already in hospital i would really benefit from home nebulisers, but have been told definitely no. I also would be very sensible, i am even happy to agree to only use a neb while an ambulance is on its way if thats what it takes, but my cons answer was still an absolute no. You have to remember that as much as you think you will be sensible, as you said in your post - you dont like your local A&E, and the neb is a way to avoid going - this could potentially mean that you think 'we'll try just one more' and then 'one more' etc. and then all of a sudden your wife is in trouble.
Its not about assuming everyone is stupid, its about understanding that no-one wants to go to A&E (especially nurses from what i've heard) and that a nebuliser feels like a good way to avoid going. This is especially the case if your wife is still pregnant, if she is then she and the baby will need to be really closely monitored when she's being given salbutamol, as it can increase the heart rate of her and the baby, and you definately dont want either of them to be hypoxic! (obviously no-one wants to be tachy or hypoxic but this is doubled if she's pregnant)
And about your wife being a registered nurse - sadly when its yourself, the sensibleness goes out the window. I am a normal and reasonable person, but once my oxygen is a little low im ridiculous, have been sat in the corridor of uni trying to argue that i am ok to be in my seminar as it was only another half hour etc. Looking back - that was impressivly stupid, but at the time i couldnt think straight!
I suspect that given a choice most doctors would rather no-one had home nebulisers, but for some people that just isnt a viable option. I know its not what you want to hear, but there is no point trying to fight this one as its unlikely that you'll get a home neb. Also, hopefully with proper control medication your wife will not need to keep going to A&E and so the problem will go away itself!
I hope things do get sorted for you both! (or all three of you! lol!)
I couldnt agree more with Soph on this one. Doctors arent being difficult here, all docs generally are extremely anxious about people having nebulisers at home because it can increase, rather than reduce risks. Being a nurse is completely irrelevant Im afraid - and I speak as one. When its your own health, and when you are unwell, rational-ness goes out of the window, as does your own self awareness about what you need and what stage you are at in terms of needing medical support. This is not news.. it happens to a lot of people, and doctors know this.
Your wife is also pregnant so to give her a home neb would be insanity itself as they would be unable to monitor the foetus if they needed to. It is not about assuming anyone is stupid, its about trying to prevent asthma deaths, which DO happen when people turn up too late for medical advice. This (turning up too late or not at all) is increased by giving someone a way of avoiding A+E when they have reduced awareness of their symptoms. If I were you, I would be grateful the docs are being sensible on this one.
Home nebs can be a double edged sword I'm afraid. There is a high chance that you could wind up heavily compensating (I've done it before, in fact last time I did it it nearly ended badly) and by that point you are then unable to do anything. I am glad of my nebulisers, don't get me wrong, they keep me from weekly (sometimes even 3 times a week) admissions but there are times when I wonder if I could be getting to dependent on them. Its not a decision that should be taken lightly and you would need to work constantly with your GP, consultant and anyone else who helps you manage your asthma.
I have them at home too (for slightly different reasons) - but there have been times that I've had a big asthma attack and if it weren't for my husband I'd be a goner, since I dont appreciate how ill I am and want to stay at home with nebs. The rule in this house is 999 now, I don't get much choice after being almost ventilated in ITU after insisting I was okay! They are certainly a double edged sword as all objectivity disappears...
I have to say, i do think i would really benefit from home nebs, but I also know that if (down the line) i am given them, it WILL have to be with incredibly strict instructions as i can see myself getting into a cycle of ""one more neb"" before seeking help last minute. For me, if i do ever get them, it will be with the aim of me needing less treatment in A&E, rather than not going to A&E (old cons talked about allowing me to make my judgement after one and only one neb) as they think early intervention might mean i need less in the way of IV medication. And this wouldn't really help with the 'avoiding local A&E as they are appauling' issue.
Also, what are the specific issues you have with A&E, is it worth complaining, or getting your wives cons to write a letter for A&E confirming her diagnosis and making treatment recommendations (i think they can make recommendations but not give instructions, but that would only be in the case where A&E was just not treating your wife i think!)?
The othera have given you some really good advice.
I have a home neb which I use daily and I am under strict instructions that if using it for an attack then if one doesn't work/relieve the symptoms then its 999.
I am too guilty of not wanting to go in hospital (lets face it, who does like hospitals) and trying the one more but like any other medications if it is abused it can lead to fatal consequences.
Without my neb I would see A&E on a weekly basis so I love my neb for that reason but would love my health to be good enough to not need a home neb ;(
I am sure if your wife needed a neb then the consultant would sort one but there are many treatments to try before this line of treatment is added x
A few years ago i bought my own neb to try an omron, used it many times and brilliant and GP knows i have one in fact he prescribed saline and ventolin nebs as when required. Back in 2011 i had a major attack used ventolin inhaler even through spacer tried 2 saline nebs as they can somtimes be effective but not as effective as ventolin obviousley with no joy so hubby took me by car to minor A & E and treated me there as my own way of treating was not working. What i am trying to say because i have never (except) in hospital used the neb in 'anger' i ws not sure whether i was doing the right thing besides hubby was very heavily hinting at 999 on the phone or car at the time - good man as my head was all over the place!!
Saline nebs are no good for asthma attacks, in fact they can cause wheezing in asthmatics - they should only be used alone when your asthma is stable to help clear sputum, or mixed with salbutamol. I had had both saline nebs and hypertonic saline but the docs at Papworth do a challenge test first in case the saline provokes and asthma attack.
Question for nursefurby or anyone who can answer:
never really seen anyone for my asthma apart from GP. i was emergency admitted a few years ago and they was not quite sure whether it was heart or lungs playing up and finally decided it was lungs by my cardiac consultant. The chest consultant who i saw thought it was all in my head as occasionally i had the odd panic attack. what started my asthma was 4 viruses in 11 months and my GP had diagnosed me way before i went in hospital after one of the viruses.
The question is would it be worth going to see another consultant and get a more professional diagnosis as half the time i don't know what my triggers are etc. I know i am cough variant, during an attack i have high sat levels heart rate skyhigh etc etc, chest clear which i have read so many other posts on hear with the same symptoms and its worrying my local hospital don't recognise this as well. i have been very well presently off steroids for about 3 months but that can change within a matter of hours/days as anyone knows
thanks
Hi Lola,
I'm no expert, but from what I understand:
1) Your care should be managed by an asthma nurse or a GP with some specific asthma training.
2) There are 5 'levels' of treatment. Level 1 is just a reliever, level 2 is reliever + inhaled steroid preventer, level 3 is those + long acting broncho-dilator (eg Seretide), level 4 is those plus a supplementary treatment, usually in the form of a pill like montelukast, and level 5 is 'more stuff' - including maintenance oral steroids (not just burst doses), physio, maintenance antibiotics, other inhaled preventers like Spiriva, or stuff like theophyline / uniphyline, or perhaps even Xolair.
You would usually be managed in primary care (GP and asthma nurse only) up to (and including) level 4. If Level 4 treatment doesn't control your asthma well enough (other than when you have a chest infection, or if you have frequent chest infections) then this should trigger referral to an asthma specialist respiratory doc, who should keep you under their care long term unless you go back down the treatment 'scale' to Level 4 or below for a decent period of time.
So - if you're already at Level 4, and you don't have good control, kick some butt to get a referral 
If you're not currently on Level 4 (Reliever + ICS + LABA + supplementary preventative treatment) then ask your Dr to step you up to the next level. If your GP doesn't know what you mean then it's time to get a new GP 
Cx
1) Your care should be managed by an asthma nurse or a GP with some specific asthma training.
x
Wouldn't it be nice if this was true for all of us! I see whatever gp I happen to get an appoitment with, who seem to have no real understanding of asthma, the asthma nurse we had has left and is replaced hu one of the other nurses, no idea what her asthma understanding is but she can't prescribe oral steroids nor listen to your chest when symptomatic. The gp with asthma as his speciality doesn't seem to know his peak flow from his stethescope! Is this fairly common, or should u be looking to change gps? Fortunately my asthma is fairly mild compared to some although am on stage 4.
I think if I was still living in the UK, I never would have been permitted to have a home nebuliser.
In Japan I've been having recurring chest infections requiring me to be nebulized many times in hospital each month which was costing me the equivalent of around £20+ per visit, so having home nebs gave me less hospital time & works out cheaper in the long run.
I did have to make a stop over in the hospital when my neb didn't kick the wheezing completely 2 weeks ago though. ORZ
Consultant doesn't believe my diagnosis 
What would you do next?
OPEP therapy success bronchiectasis
