British Lung Foundation
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Another quick question:

Anyone know how many puffs of salbutamol you take when using the inhaler with a spacer? I haven't thought the inhaler was working for me for ages and have been using a nebuliser for delivery but my respiratory nurse is encouraging me to try again and not use the nebuliser as apparently the receptors in your lungs can get 'flooded'. I googled this and came up with - what d'you know? - the HU asthma forum where I found a long discussion, with the most prevalent opinion being that this is correct.

So I've just taken five puffs, breathing in and out 5 times. Is this about right?

Thanks all, and thanks so much for fabulous response on other post, so many useful suggestions. Hope everyone's as well as possible today. I am a little better and everyone's replies helped me get through yesterday :) :)

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Hi O2, I’ve just asked Pete and he takes 2 puffs of salbutamol using his spacer.

I’m sure his needs are different to yours though so doubt that helps much. Take care and glad you’re feeling a bit better. Xxxxxx

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Im gonna have to get more clarification from my resp nurse Sassy, but all the feedback has been very helpful, thanks xx :)

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Hi O2, I usually take three puffs then breathing find d times. Take care hope this helps. Love Bernadette 😊 xx

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Yes helpful, good wishes to you Bernadette, xx jean

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I use a spacer, and breathe in slowly whilst taking a puff, hold my breath for as long as I can, relax, then take a second puff. I don't rush them. I have always been told not to take more than 8 puffs a day. If I feel my breathlessness/Severe Asthma isnt getting better, then I will switch back to using the 2.5mg nebules with the nebulser 4 times a day. Salbutamol/Ventolin affects your heart, which is why they are probably encouraging you to try the spacer again. I find it really does help. I don't feel it working unless I use the spacer.

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Thanks Anne and everyone :)

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Do u think using a neb can give u swollen feet n legs

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Why do you ask Karenblue? I have had legs swollen up to my knees but only when Ive had pneumonia. I am using nebs then but also I can't lie down so sit up to sleep so gravity plays a part. It goes when I get better though it takes a few weeks.

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Hi 02 trees I was in hospital for 3 weeks which ended up me home with a bibap

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Machine slip if finger lol all the time in hospital I had swollen legs n angles had lots of test done all ok I’m on water tablets the higher them then bk to normal dose just wondered since late March till now I still got it worse if night they feel heavy n tight

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I wouldn't really know Karen - when they are bad they always feel tight and heavy to me. Skin is shiny too.

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I’m glad u got ur puffs right lol I’m going to phone dr tom he did say abt st Jospeh s hispice to fit me compression stockings god lol I got stage 4 copd

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Talk to your Doc about that Karen, you may need med to reduce water in feet and legs.

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I do not know the answer to that one. As other people suggested, I would see your GP about it. When I am on steroid doses of 20mg or higher a day, then my ankles and feet can swell up. Luckily they go down again when the steroid dose is reduced to 10mg. I never used to have this problem, just started this year, the swelling I mean.

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Been on steroids never had it before

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Hi

If using a AeroChamber

One puff one breath slow and steady, or one puff and four tidal breaths, ( chest breathing. Hold for ten or more seconds

Repeat for second puff upto the prescribed dosage or any recommendations by your respitory nurse.

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Great directions, cheers Stone :)

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Hi... I'm being dim but what is a tidal breath please?

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Hi

With mist inhalers you normal take one slow and steady breath.

If can’t do this four/five normal breaths ( tidal breathing ) will empty the chamber. You are probably it doing now while seated, just chest breathing.

nnuh.nhs.uk/publication/dow...

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Thankyou ....I understand now 😀

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What does she mean by ‘flooded’ please.

Cx

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Tbh I havent a clue Cof, other than what I can surmise from a common sense point of view, but no clinical understanding. I assume it means the receptors are kind of overwhelmed and maybe don't function so well, or perhaps if they are flooded with one medication, then others can't get in. Who knows? I will ask my respiratory nurse when I next speak to her.

How are you now Cof? xx

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Hi Cof, here I am with the explanation from my respiratory nurse, bit more than I could provide anyway and different to what I said.

Apparently since the nebbing of salbutamol is in larger droplets than the powder from the inhaler, they can kind of block the receptors and actually get into the cardio receptors which may increase the heart rate too much. Im sure there's more to understand about that but that was what she told me. x

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Thank you for taking the trouble 02. I do get fast heart rate with Salbutamol but that is with nebulisng or inhaling. I will have to carry on nebulising terbutaline twice a day, as it helps prevent bronchospasm when I follow with nebulising hypertonic saline. It’s all such a balancing act, made all the worse when taking into consideration all the medications I have taken over a lifetime of bronchiectasis and the start of the NHS I, along with others, have beed taking medications which have never been trialled specifically for this condition! Imagine if that were the case with a condition everyone had heard of.

Love cx

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Terbutaline sounds interesting Cof - what class of meds is it? I just looked up and it seems to be a short acting bronchodilator for occasional use so I assume pretty strong. I used to be given aminophyllin for asthma years ago but it never worked so they moved straight over to pred. I might ask my nurse about Terbutaline. What a learning curve and you've been going for so long. Meds can be so scary. xx

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I've used terbutaline for many years now. I was changed over to it because I am actually allergic to ventolin - my lungs gradually fill up with fluid and my breathing becomes much worse. I only need to use Bricanyl (terbutalin), maybe once or twice a week during pollen season, and only every few weeks nowadays if the pollen is normal, but I feel my asthma has decreased considerably in severity over the years. Nearly died a couple of times in my 20's and 30's. My husband, who has COPD, changed from Ventolin to Bricanyl as he finds it more effective, but he doesn't have to use it too often. I wouldn't say it was a stronger drug, though, but it doesn't give me the dithers like Ventolin used to.

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So interesting Jac401 - Im going to speak to my doctor, thanks for the info.

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I was given aminophyllin in hospital got home n was having panic attacks n heat beat fast I used drive my rn mad for this

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That never worked for me Karen either, I hated it and always resist attempts to give it to me now, and Theophillyn which is similar.

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It is a bronchodilator similar to Salbutamol. It doesn’t give me the heart dithers anywhere near the same as Salbutamol. I nebulise it twice a day prior to hypertonic. As you know I have bronch and asthma.

Very scary as you say, especially as none of the meds we take for bronchectasis have actually been trialled for us!

Cxx

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I know, we're guinea pigs Cof, though my bronch is only around 4 years old and you've been dealing with it for years haven't you? Thanks for reply re Terbutaline. Gp will be getting a call :) x

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10 puffs = 1 nebulizer xx

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Thanks frose - I thought that might be it. xx :)

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Although ... I never got on with the spacer either and opted for 10 puffs taken straight 😂 get better soon x

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Cheers! xx

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Like frose I find that sometimes taking Ventolin with the spacer has little effect for some reason and need a couple of straight blasts shortly afterwards.

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Hello again. Ive been told by a doctor, a respiratory nurse and a Respiratory PR nurse that in using more than one inhalation with metered dose type that you must wait 30 seconds between each one. Reason being that it takes that long for the drug to 'drop down'. If inhale immediately after the first then you only get the propellant. I still make sure I wait the 30 seconds between taking two Fostair inhalations. Try it, see if it makes a difference. X

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Wow, I knew you are meant to wait but didn't know why. Im a bit undisciplined about that so thanks! Im having the same as last night - sleep til around 5.30 (which is great actually) then have a hideous hour of trying to get the stuff up. Its in the upper respiratory area but won't respond to anything, or it feels like it isn't though i think it probably is slowly coming upwards. Doing active cycle of breathing, using a steamer intermittently, but every so often it totally blocks my airways and I feel like Im drowning and its terrifying. Rita has been up with me but she's got this virus now too so I've sent her back to bed. Hope you're sleeping P xxx

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Have you tried using a 'flutter device' Jean. It really works in loosening the mucus :)

nebulisersdirect.co.uk/inde...

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Yes, I have one and it's doing b*gger all at the moment. I'll check out the vid though to make sure Im doing it right. When Im well it works a treat. Thanks James :)

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Slept 12 to 7.30 thanks. Was hoping for 10 hours to help get over the fatigue of 10 days with Raf who's now a joyful 2.5 and very very 'busy'.

Anyway, I've also recalled why we use a spacer, because it administers 50% more of the medication. That was from the excellent respiratory nurse who came to the education part of PR.

Hope this nugget helps too and that your on the up. That choking sounds scary. Effervesant Vitamin C to bump up the immune system to fight that pesky virus 😘😘

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Not sure what to do re Vit C since it is an iron absorption enhancer and I have this stupid haemochromotosis iron overload thing. Though since Im having the blood letting now (twice) if my iron goes too high I can just have another of those so maybe shouldn't worry. What would we do without the NHS, for all its (underfunded) faults? Thanks for all your support P. xxx

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Ah yes, so sorry, I momentarily forgot about the H thing. B*gger

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Well as i say, it could be fine - I would just go for a bleed to reduce iron levels if they went up, which they can do due to inflammation anyway. Mine were high but only 209 and they got it down to 50 units with the bleeds which is good. But i read on another HU forum of some people having as much as 10,000 units of ferritin (the stuff that stores the iron). 10,000 - jeez, why would I worry with my puny 209 haha! x

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Don't know if it helps, but I had terrible probs with 'concrete mucous' until I read on the forum that a lot of members take N-ACETYL CYSTEINE (readily available) and hey, it works!! After years of using everything available success Hope this is helpful

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Yes, if you look at the nozzle inside the plastic case, you will see it's all frosted up immediately after releasing a dose. You need to wait for the frosting to melt before pressing for the next dose.

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Don't know what I'd do without this forum :) :)

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It should be the same amount as you would take without the spacer 2 puffs with a minet between puffs. The spacer alows you to breath your meds in a much more relaxed way

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Thanks corriena :)

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As respiratory medics advise really. Each patient may have been told different for specific reasons.

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I know - I need more advice really.

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I have had difficulties with Ventolin inhalers too......please O2trees, if you are having further problems check with your surgery or ring the BLF helpline for advice.

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I will knitter - this is just so hard right now.

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I can imagine O2trees. As a new Nurse Practioner said to me the other week' you know your body best' .

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Hello. My usual dosage is 2 puffs through spacer, breathing in with slow count to 10. Shake inhaler again for 2nd puff, again slow count to 10. If I have infection then 4 puffs in the same way. Hope this helps. Good Luck

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Yes definitely helpful - that's what Ive decided on, 4 puffs, til I can speak to my resp nurse. Thanks Hoping2improve :)

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I have only known 2 puffs advised

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Depends on your level of illness I think Chriskho. That was what I took for years (since my 20s) but tht stopped having any effect long ago. I was taking 4 salbutamol nebs in hospital - I was sicker then - which = 40 puffs a day which sounds crazy. So my sense now is that 4 puffs around 4 times a day which would equal around 1 1/2 nebs in strengths is about right for me in my current situation but I will ask. I'll come back and let you and others who've been concerned what the nurse says.

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027Trees

Hi, I suggest you ask your GP or a medical nurse to say what is best dosage for you.

IKeith

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Hi O2Trees, please return to your asthma nurse you obviously need to go through the whole process of how to use your salbutamol. 8 puffs per day is the norm, after this you would probably suffer some shaking as this is a reaction to too much salbutamol. Salbutamol is a reliever inhaler and should be used before exertion. 2 puffs at a time with a count of 60 between puffs. If this is not working, you should see your asthma nurse. Good luck, I am sure your nurse will sort you out. Take care, Maximonkey

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I think it's a bit different if you have other lung conditions complicating it and you're having a flare-up. I have had a lot of advice and was prescribed the salbutamol nebs 4 times a day in hospital, which is equivalent to 40 puffs of the inhaler (see Frose's reply above)! I know, seems huge. But I am in a serious flare-up at present with nearly stage 4 emphysema and bronchiectasis as well so it's more complicated. I shall confirm best amount for my current situation today when i speak yet again to my respiratory nurse. I am aware that when salbutamol was introduced in the 50s (I think) there were many more asthma deaths recorded so it's clearly an issue. My plan today is regular saline nebs which don't have the receptor flooding problem that salbutamol can produce. Thanks for your concern.

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Ok, up to date instructions from my respiratory nurse and you were all more correct than me which was what made me think I must clarify with my nurse, so thank you for that.

So, it's 2 puffs 4 x day, but I can take one extra if I don't feel the two are working.

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I’m pleased that you have got the answer to your problem . Good luck

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Hi sorry to be so stupid but what is a spacer please?

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You're not stupid, how would you know if you've not come across one? It's a big clear plastic kind of cone shaped thing which fixes between the inhaler and your mouth. You breathe 'normally' five times after firing off the inhaler. The idea is that it gives you more time to get the stuff into your lungs and is an easier technique to manage.

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Thank you for explaining to me I might ask for one if it makes life easier

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Yes, probably worth it. As well as making it easier to breathe the stuff in, it is also meant to enable more of it to actually reach the lungs.

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