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Blue Inhaler (salbutamol)

Hi everyone

yesterday someone called PMR pete said an interesting comment that got me thinking. You can only have 8 puffs of salbutamol in 24 hour period. This is not true as I did explain but it just shows how we are all told very different information from our professionals. On the Asthma UK asthma plan it says when calling 999 to take ten puffs of your blue inhaler and if an ambulance does not arrive after fifteen minutes take another ten puffs of blue inhaler. If what PMRpete had said was true it would mean Asthma UK was telling people to overdose. Please people check out information you are given with Asthma UK do not just trust your professionals. Yesterday I had to check out a medical professional and it turned out they were incorrect.

Blue (salbutamol) inhalers you can take ten puffs every four hours that is sixty puffs in a twenty four hour period. If this is not working go to hospital and they can check you out! Hospitals prefer to see you alive and struggling than dead! Hospitals can then prescribe you higher blue (salbutamol) inhaler doses and monitor you whilst you begin to recover. Whilst on more than sixty puffs a day you need monitoring by doctors and nurses! You can only be monitored at a hospital! This information is all in an Asthma UK Asthma Plan I have just put the maths into words as some people need it!

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Well the notice usually says 8 puffs a day so that’s why people think so I suppose.

Of course follow your medical instructions. They are tailored to individual medical needs. We all have our own medications and prescriptions so I wouldn’t issue any general recommandations.

Take good care.

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I have not typed out what I have been told to do! Re read what i wrote and look on Asthma UK website. Go to the resources and read the Asthma UK Asthma Plan document. It is what Asthma UK have written! The only difference is Asthma UK say if you are taking ten puffs of your blue inhaler every four hours and it is not helping ring 999. I put the maths which is 10 puffs at every four hours which equals sixty puffs in a twenty four hour period because there are 6 four hour parts in twenty four. six times ten is sixty. I have not given any medical advice I have merely given maths!

It is Asthma UK who have given the advice in there resources section!

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A lot depends on the depth of knowledge that the GP has about asthma.

Several years ago, my GP (who had a wife & child with fairly serious asthma) told me that you could fairly comfortably take c.50 doses (of salbutamol) if you needed to, without side effects, as long as you realised that the implication was you needed emergency treatment. But stopping at 8 & collapsing isn't a great strategy really.

I have gone beyond 8 numerous times over the years & always keep that advice in my head. Needing to take it more than once or twice a day means you're not controlling it well, which means seek advice. Taking it into double figures means I have an urgent need to get help.

I have been incredibly lucky in my time to have had a GP with real-life experience, and now a GP who is highly sympathetic (I now have additional lung complications), but some GPs will only advise what is in the formal guidance. Which, of course, is a very sensible and professional thing to do.

As a wise person once said to me though, doctors receive extensive training on treating illness, after which they have to go out and learn how to treat people.

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I have to admit that if I reached the stage of needing eight puffs of ventolin in a day I would be contacting my GP surgery and requesting an urgent appointment. It would indicate to me that my asthma was out of control, that what I have at my disposal was not enough to bring it back under control and therefore I would be in need to additional medical help. I'm fairly confident that the reception staff at my local surgery (who know me well) would do everything they could to fit me in. Like Minushabens, I'm fortunate in that the GPs at that practice have been dealing with me and my asthma for over twenty years (and have seen what it can be like when it does spiral out of control) and so are very sympathetic.

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I am only telling people the maths of what Asthma UK Asthma Plan states. I feel it is unfair that I am being shot down for just explaining the maths for the red section. If people really do not like what the red section of the Asthma UK Asthma Plan then Asthma UK should

be emailed.

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I'm not shooting you down, and I don't think (having read all the replies) that other people are doing that either. You raised an interesting point. All I was doing was stating what I would do if I had reached the stage where I needed to have that much ventolin in a day (and it is a lot of ventolin). I would be seeking medical assistance, irrespective of what the written advice is on how much ventolin you should or should not take in a twenty four hour period.

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i never said do not seek medical advice. go and sit in A and E each time you take one puff of blue inhaler I am sure you would be reassured by the brilliant staff. Just never worry about over dosing with a salbutamol inhaler. the worse that could happen is a person be too afraid to take enough to keep them alive to get help.

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Er - can I suggest you re-read my original response and note the nature of the medical assistance I would be seeking. Can I also suggest you re-read what I say about them.

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I have semi-regularly had more than 8 puffs of salbutamol in a day. I run and a few years ago i used to regularly run 10k races - i would regularly need more than 8 puffs in a day after a race (and that was with taking it before i started). On at least one occasion i remember taking at least 10 x 2 puffs over the course of a race day, 8 of those puffs within the space of a couple of hours. It also used to take me 3 days to fully recover my breathing after a race. I admit maybe my asthma wasn't as well controlled as it may have been but when i wasn't running i FELT perfectly well

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If I needed 60 puffs of salbutamol in a day is be making noises... loud ones at my gp practice/urgent care/ a and e (anywhere suitable)

I was once told that you can't really overdose on salbutamol and the amount you would have to take is so high that you'd need a handful of inhalers to do it

I take it if I need it if it's not working I take more if it's not lasting very log I seek suitable medical attention if I'm concerned I go to a and e/urgent care... I quite often take more than 10 puffs when I'm not doing well... And when I am I don't take any (sometimes for months)

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If I couldn't breath properly (again) how many puffs im taking wouldn't even enter my head. I just know what ever amount I was taking didnt work I need help. I was told I can have as many puffs as required before I get urgent help and to do so through a spacer as it acts as a nebulizer.

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I was told to use a spacer if I was in difficulty as well. I normally use an accuhaler for my ventolin, but if I'm really struggling I have the evohaler version and a spacer to use instead.

One thing I do find if I take more than the usual two puffs of ventolin is that it can make me feel quite 'woozy' (for want of a better word) and that will get worse the more of it I take. Basically I begin to feel light headed and I find my hands can begin to tremble. I also find that if I take quite a lot in one day (and for me 'a lot' would be the eight puffs I mentioned previously) I can end up feeling unwell in a different way to that of an attack. As I said, 'woozy' is the only word I can use to describe it. I'd be interested to know if anyone else gets that. I rather suspect that I'm not the only one.

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Yes I can get woozy too after so many puffs.

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Yes, I get light headed and dizzy if I take 4 or more puffs, the more I take the worse it gets.

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I have mild shakes and palpitations after 4 puffs. I once had 7 puffs and a nebuliser and had awful palpitations and shakes and felt awful for the rest of the day.

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With medication, with exception for emergencies... you are meant to use the Minimum Effective Dose. Use of higher or more frequent dosing is a sign that control of symptoms is not being affectively achieved at lower dosage.

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When I have had bronchitis and my asthma was badly effected I was told I could take as much as I needed but there are side effects like faster heartbeat and the shakes so you take as much as you need to help your chest. In my case I can double up on my preventer if I have a bad cold or flu

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Thank Julie for highlighting this and for putting it in such simple terms.

I read a similar post yesterday and one of the replies mentioned NICE guidelines: so I looked them up and here they are bnf.nice.org.uk/drug/salbut...

In a nutshell for normal asthma the recommended dosage is "100–200 micrograms, up to 4 times a day for persistent symptoms." (A puff is 100 micrograms so this is where the 8 puffs a day comes from i.e. 4 x 2 100 microgram doses)

However, for life-threatening acute asthma the recommended dosage is "2–10  puffs, each puff is to be inhaled separately, repeat every 10–20 minutes or when required, give via large volume spacer."

Hopefully this reinforces what you stated.

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thank you!

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Surely the main point is that Salbutamol is a RESCUE inhaler, and you take as much as you need for that purpose. If you need to be "rescued" often, then it suggests that you need a different PREVENTER. I am aware that some asthma sufferers can get away with a few puffs of Salbutamol a day, and that might explain the "8 puffs a day" prescription - beyond that, I imagine that they should be on a preventer.

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some are on top licensed doses of preventers and still have to use rescue inhaler. I think it is positive how much science has advanced and how asthma does not mean living in an oxygen tent as it used to 50years ago.

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Oh yes, definitely. My father lost two uncles to asthma, and as I was undiagnosed for five years when I was a small child (fifty years ago) I'm all too well aware of what it can be like not to be on medication.

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Superzob, that is correct. That is why I say that if I get to the stage that I need eight puffs of ventolin within the course of a day I will be contacting my GP and getting myself checked out to try to find out what might be causing the problem. With me it's most likely to happen if I'm brewing an infection, though going in to a property where there is a high prevalence of dust mites or damp will do it as well. Most of the time I can manage with just my preventer inhaler, but if I think my asthma is beginning to spiral out of control (and needing to take frequent doses of ventolin would indicate that) I will seek help before things get really bad.

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just like being on top preventer dose and not being controlled should cause you to book an asthma review.

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At the very least.

In my case it's rare for my asthma to go out of control (though it does happen). I have an annual asthma because it is well controlled (I'm due to have this year's review in the coming fortnight:-)). But I was getting things checked out at my local surgery just a couple of weeks ago because of a persistent cough resulting from an infection. This was despite the fact that I'd upped my preventer intake to maximum the moment the infection had started. To be honest, it didn't feel like asthma, and ventolin had no impact on it, but I still made an appointment to get things checked out. My concern was that a chest infection might have been brewing. And I think we all know that chest infections can be very bad news for asthmatics.

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I took around 30 puffs in a 24 hour period on Thursday. Randomly went crazy! Since then needed about 5 to 8 a day. Despite my changeable asthma, I've been advised not to hesitate using reliever or even take before bed even if I don't need it

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Thanks for the info. I can verify how so called professionals can differ so much. I visited my GP not long ago, I was seen by a doctor training to become a GP. She told me never to exceed two puffs of Salbutamol more than three times a day! I shook my head in disbelief, can you imagine struggling for breath but having already used my inhaler three times being told you can’t use it again! Somehow I doubt if this ‘doctor’ is GP material. Naturally I treated her advise with contempt.

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I've never been told that. I have used 6 in one go before now and I remember being quite nervous about doing so at the time despite the fact that I had been told that was fine by my GP on a previous occasion. I have a feeling that was the occasion I ended up on oral steroids. The reason for the flare then was a viral infection.

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I have to take 2 puffs in the morning before Clenil &Spiriva then 2 at night before Clenil. That would only leave me 4 per day & supposed to use it before any exertion.

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I have cough-variant asthma and my inhaler to prevent is Symbicort and the rescue is Albuterol (or equal) 2 puffs every 4-6 hours as needed. My cough has really gotten bad in the past two weeks and I increased the Albuterol to 2 puffs as often as needed even through the night and it has helped my cough a great deal. I'd estimate I'm using ~20-30 puffs per day. The main side effect is shaking. I can feel my pulse more, but the rate doesn't seem to increase. I don't understand that. My BP stay normal. Thanks for all the helpful comments.

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