Adverse Reaction to Salbutamol

My 13 year old had an asthma attack in August, she had had 12 puffs of her blue inhaler before I took her to A&E. They gave her a further 30 puffs there and sent us home on a reducing regime which meant taking 10 puffs every 4 hours for the next two days. By mid-afternoon the following day she was tight-chested, having difficulty breathing and suffering from chest pains. We rang the hospital and were told to come back in.

On arrival they gave her 10 more puffs of Salbutamol and that's when the fun really began! Her heart increased to 137bbm, her blood sats dropped to 72%, if she had been able to she would have been screaming in pain. They gave her steroids and an anti-histamine and something else to calm her down but didn't really seem to know what to do. Eventually, she was well enough to go home but we were told that in all likelihood she had had an adverse reaction to the Salbutamol and not to take it again.

We saw her asthma nurse the following day and she gave her a turbolhaler but warned us she could have a similar reaction to it and that if one puff doesn't relieve her symptoms then we are to go to the hospital.

At the moment she (nor I for that matter) doesn't feel safe as we don't have a reliever inhaler and she is on maximum doses of both her preventer and her long term reliever.

We are due back next week and I wanted to know if anyone else has had a similar experience and if so what was the outcome?

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Hi !

I am 19 at the moment and I use that much salbutamol too on a daily basis as I have what they call as brittle asthma and salbutamol does have side effects i took about 50 puffs before my last attack a few days ago my blood pressure was more than 200/100 and pulse was more than 160 bpm and sats were 90 ish on arrival at a and e than they gave me some nebs and put me in waiting room where in minutes i was going downhill amd ended up in resus as everything just dropped and they gave me more iv stuff like magnesium and hydrocortisone. I am on max treatment for asthma and attended many difficult asthma clinics and now moving to be under the care of the Brompton to try to sort me out.

On a normal day for me I usually shake a lot as a side effect of salbutamol my heart rate is 120 when I am fine and I wheeze almost 24/7 any time someone listens to my chest they can hear wheeze. Cannot climb up a flight of stairs without having to use salbutamol and wake up everynight breathless.

At the moment i have

Salbutamol

Seretide 500 2 puff x2 a day

Tiotropium 18 mcg 1 puff x2 a day

Uniphyllin 300 mg 1 tablet x2 a day

Montelukast 10 mg 1 tabletx2 a day

Prednisolone 40 mg at night each day

Omeprazole 20 mg with the prednisolone

Vit d tablets

And flixotide 125 2 puffs x2 a day

Just too much medicines and got nowhere with it

But what they did was dangerous at your case. They usually start with nebs amd steroids if thats not enough or if sats are lower than 92% they do an abg measurement and treat with oxygen and other things. But if you take more than 10 puffs of salbutamol a day it is likely that you will get side effects like heart very fast shaking which I get a lot of and so on.

If you read the guidelines for asthma which you can find on google just put in asthma guidelines they should have given much more to your daughter to treat her attack. Sats only usually fall that low in very bad attacks.

I am not sure what medicine is in the turbohaler but if its bricanyl it has the same action but less side effects as both salbutamol and terbutaline (thats the medicine inside bricanyl) are b2 agonists but bricanyl just has less side effects and if its symbicort it has a long acting b2 agonist and a steroid in it so it works in a slightly different way to salbutamol. But should give relief of symptoms. Its called the symbicort smart regime.

Hope this answers some of your questions and if you got any more dont be afraid to ask might be able to answer them

And hope that your daughter gets better soon

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Thank you for your reply, Yas.

It sounds like you have a really bad time of it.

I had to look up what an abg measurement was and am quite glad they didn't do that, don't think either of us would have coped very well with it.

The trouble we have is that she rarely if ever wheezes so we are often left sat in the waiting room after the triage nurse has seen us and classified as not urgent because no wheeze has been heard even though I make sure to tell them every time that she doesn't wheeze! Her main difficulty seems to be breathing out and on one occasion when there was a respiratory registrar on duty she was admitted as he spotted her, as he passed the waiting rooms,. she was was grey in colour, very lethargic and he was worried about the CO2 build up in her body. But most of the time we sit and wait while she gets gradually worse and panics which doesn't help matters. She has only had nebulisers a couple of times, usually they just give her steroids and 10 puffs of her blue inhaler as often as she needs and keep us in until she can go 4 hours without needing to use it.

Not having recourse to her normal ""blue"" inhaler scares her and I think the reason they told us not to use it was because of the rapidity of her deterioration, and possibly because they didn't have a clue what to do..

I keep thinking we have it under control but every six months or so she will have a massive attack out of the blue and it takes more and more to get it back under control. She has been on adult doses of her inhalers for a while now and she is not particularly big for her age. Just not sure where we go from here or even what questions I should be asking.

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I would say if she is going lethargic or bluish in colour (like me a couple of times now) thats when she is real bad. Last time what happened in a and e was that i went in with those sats (literally walked in) they put me on a neb straight away and after the neb gave me oral steroids and put me in the waiting room without seeing a dr. Then what happened in 10-20 min time was blue gray in colour and couldnt breathe so someone very poorly went to get a dr for me who took me straight to resus he listened to my chest but couldnt hear anything at all as i stopped wheezing as so little air was going in and out my sats and blood pressure and heart rate dropped massively and got almost intubated was nearing that end and was kept in hospital for like a week to get stabilised i needed like 6/7 h on nebs and lots of iv stuff which i cannot name all but had magnesium theophylline steroids maybe salbutamol or terbutaline and fluids . Had lots of abgs as well as oxygen levels drop and was kept on oxygen for a few days amongst with the nebs .

But if your daughter is going blue than its usual to not to wheeze as the chest gets so tight that it cannot make a wheezing sound which is a sign of a more severe attack. Drs call going blue as cyanosis.

According to the guidelines a severe acute asthma attack is when

Heart rate greater than 110 beats a min

Respiratory rate (how many breathes you take a minute) is greater than 25

Peak flow 33-50%

And inability to complete a sentence

Than there is life threatening attacks which have the signs

Going blue-cyanosis

Silent chest

Oxygen level less than 92%

Hypotension

Altered conscious level

Etc

To me it happened previously that i went to a and e and they told me here is another inhaler use that you seem allright when I already used up one entire inhaler in a day. So by the time i got home i was even worse and my flatmates just rang me the ambulance despite that i was saying no. Then when they arrived i was blue had a silent chest -no wheeze or no sound of breathing sats were low and were dropping and couldnt say a single word so got rushed to a different hospital where the dr was rather terrified and they too almost had to intubate me in resus as had a build up of co2 but had a good response to treatment. That time was unconscious by the time i reached the hospital so cannot say what they did to me but got admitted to intensive care.

So what i would say is maybe try a different hospital or try to go by ambulance or maybe see the gp with urgent appointment and they might send her to hospital or maybe a walk in centre I did those a few times i only became wheezy like the last 2 month before it i was in the same shoes.

Also where do you live? And which hospital is that? As no hospital should leave her with such sats . Maybe put in a complaint against the hospital sometimes that helps.

When i lived in london i been to about 6/7 hospitals but like 3/4 of them DID leave me in lifethreatening attacks and sent me home with an inhaler and steroids and i went to another hospital straight after and got admitted as i was too bad by then.

I m not telling this to scare you but i think that the hospital is no good and not safe try to go to another one.

Here is some formal advice according to the guidelines its from page

90 that gives you advice about attacks

brit-thoracic.org.uk/docume...

[juliesharp]

Next time your daughter has an attack try taking her straight to your GP if they are open. GP may respond differently and the more the GP see your daughter ill no wheeze the more the GP will want to help.

A and E are not good with none wheezers!

Or if possible try a different A and E or a walk in centre to see if you get a different response. Your daughter really needs help but funding cuts will be hampering. You could also ask your local mp if they can send a letter to prod GP along a bit.

It GP role to get your daughter a proper diagnosis and correct help.

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Hi

sorry your to hear this. Try seeing your GP and asking for a referal to an asthma clinic. If you have a good GP they can also look up what other inhalers your daughter could take.

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I'd ask them to look into her reaction, to me, if she has had loads and loads of salbutamol in the past and been fine then it seems like its unlikely to be a reaction to the salbutamol - as why would it never have happened before!?!

Where was her pain? Heart rate of 137 isnt that surprising given the amount of salbutamolshe had had and the fact she will have obviouslty been working hard to breathe. Sats of 72% seems unlikely unless she had the classic blue tinge (and frankly id be surprised if she was fully conscious) - was that measured with a finger probe - they're notoriously unreliable, did they stay at that level for extended periods while the probe was on her finger? were her hands cold? was she wearing nail varnish? anything cutting off the circulation to her arm (like BP cuff)? All those can give a folsely low reading! If she was having the pain before you arrived it sounds to me more like either typical muscular pains from asthma, or infection type pain, both of which could potentially get worse. I dunno, it just seems to me that it was a very typical presentation for a nasty attack, and so the worst thing to be doing if that is the case would be to stop salbutamol.although obviously if it were the case that it was a reaction to the salbutamol then you'd wnt to know about it!! It would make sense to me (and i'm not a doctor and dont know what doctors can even do) but I would want to put her on some kind of monitoring, and give her a good old dose of salbutamol and see what happened. Was your daughter in resus when she deteriorated before? Did they seem panicked? Do you know what her BP was? If it was the case that her sats did drop to 72% and that wasnt an inaccurate reading then i'd agree that its very concerning, if that was false then it all depends on how severe her other obs were!

Does she usually get relief from the terbutaline? Its a pretty decent inhaler but some people struggle to use a turbohaler when they're having issues! Is your daughter under a resp cons? If you do have issues finding a reliever it would definately be worth geting a refferal to one!! It might be that she could try using atrovent as a reliever as opposed to salb/terb as atrovent (ipatropium) has fewer cardiac side effects I believe!