What's the maximum brown inhaler dose?

[MNerAnon]

DS is too young to diagnose asthma but GP suspects it.

We've been instructed to use blue inhaler when a cough starts and proceed to brown if cough doesn't improve after a couple of days. The idea is to avoid unnecessary overuse of steroid inhalers and help record the likelihood of being asthmatic.

Friday night DS developed a 'bark' with tight wheeze, so we used both inhalers straight away, twice daily as prescribed. We didn't eat to mess about in stages because he sounded awful! The cough improved and last night we decided to give only the blue inhaler, with disastrous results.

By about 10pm DS sounded like e was drowning as he lay on his bed asleep. He was grunting with each breath for a short while, until he coughed and then breathed exaggeratedly slowly for a while until the next cough. We immediately administered 2 puffs of each inhaler and that helped a bit. It took about an hour for him to be relaxed in his sleep as for the cough to subside with him being propped almost upright in bed.

This morning he woke hacking at 4am so we have both inhalers again. I'm aware that we only have one dose left if we adhere to the prescribed amount, but I seem to vaguely recall last winter we were allowed to give 4 doses of each inhaler and not just 2. However I've lost the paper that comes in the box and can't read up on it to check my memory serves me well. Can anyone tell me what the maximum dose is?

He's bright and eating, just has a cough today. I wouldn't say he's even particularly wheezy today and certainly isn't sounding like he's drowning in his secretions like he sounded last night! So I am reluctant to visit the GP yet, especially if we could have given 4 doses with great success, if you see what I mean.

[MNerAnon]

The brown inhaler is clenil modulite 50 (beclometasone dipropionate 50mcg)

[Gileswithachainsaw]

Why don't you call and ask for a phone appointment?

we only have blue inhaler nut going by other asthma threads what we were told differs from what others have been so best bet is to speak to your own drs and clarify.

how old is your ds?

[Gileswithachainsaw]

I will say though that I thought the brown inhaler was a preventer that you take on a regular basis even if well to help prevent and reduce severity of the attacks.

the blue one o's to open.the airways when they are struggling to breathe. the brown doesn't help with this so o think.theres been a mix up somewhere. although I'm. Sure I will be corrected

[tshirtsuntan]

We have this with my ds, the barking/ wheezing cough responds to steroids so Brown is right for this. I would visit gp today even if he seems ok as he may need extra steroid (prednisone is the one we are usually prescribed- not sure if that is spelt correctly?) Also just to check dosage as all children are different and dosages vary, I'd want to be clear as these things always get worse at night. Hope he feels better soon

[Littledafty]

My ds has both, because the weather is colder now we have been told to up the brown preventer inhaler to morning and night instead of one dose in the morning. This is alongside using the blue whenever required. We were told this two weeks ago when he was in the middle of an attack so our dr recommends increasing the brown at times when they're struggling.
I'd give your dr a call and get clarification just for peace of mind.
We've always been told by the hospital if we're remotely worried they'd like to see us, and not to worry about wasting their time. With something like asthma I'd always err on the side of caution. Hope he feels better soon.

[INeedNewShoes]

You need to see a GP today with the symptoms you're describing.

The brown inhaler doesn't offer immediate relief - it's a longer-term preventative measure.

There are lots of different inhalers available and it can be a bit of a journey finding the right medication/dose but if he's struggling for breath it is imperative to seek medical help.

[Sirzy]

You need to see an asthma nurse, or a different GP.

It takes up to 6 weeks for clenil to be at its maximum effectiveness. It builds up in the system. It is a preventer inahler to prevent the attacks (or reduce the severity of them) it is not designed for use in an attack.

[MNerAnon]

Thanks everyone. I will visit a GP again today. The GP had mentioned he was reluctant to go down a regular steroids route if it wasn't asthma, so maybe explains why he said to stop-start the inhaler. But if it wouldn't be therapeutic it makes little sense! Would you have been worried by last night or is that normal? I don't want to be paranoid but obviously I do want to be responsible!

[Whataboutreindeer]

Doctors often will not call something asthma in a small child, j don't know why but they are very reluctant. You need to get good advice about inhalers, the brown he probably needs every day if he is having regular episodes, even if just for winter. This is how I use mine. we give my son up to ten puffs of blue in an hour, if he needs more in a specific window then I get help. Steam helps, making sure they user their spacer really well is key too. My son is two and diagnosed asthmatic, he has two puffs of brown a day and montelukast granules and regular use of a blue inhaler. It's so frightening hearing them struggle. Go and see your GP and get some support. Never be afraid to call 111 or 999 in the night for a child that is struggling to breathe.

[SweetTeaVodka]

I'm a paediatric nurse and see lots of wheezy and asthmatic kids in my professional life. The advice your GP has given re: brown inhaler is not what the paediatricians I work with advise.

The brown inhaler (beclometasone) is a long term preventative, it doesn't work short term and can take a few weeks to be fully effective. Using it just during an acute attack is not helpful. In an acute attack a short course of a higher dose of steroids may be required, but this would be in the form of chewable or dissolvable tablets (prednisolone, as mentioned up thread by a pp). The brown inhalers come in different strengths so the number of puffs advised will depend upon that.

The blue inhaler, salbutamol, is a reliever that works by relaxing the muscles in the airway therefore making it easier to breathe and reducing wheeze. We advise that during periods of illness it can be given up to every 4 hours. If the child needs it more frequently or more puffs a time then they need to be seen by a dr that day. The blue inhalers are all the same strength regardless of brand.

If a child or baby is struggling to breathe (nasal flaring, pulling in on the chest/between the ribs, head bobbing or pulling in the throat when breathing are all signs of respiratory distress) then you can give up to 10 puffs of the blue inhaler and then call 999.

When we discharge children from hospital with inhalers we send them on a reducing regime - 10 puffs 4 hourly day 1, 8 puffs 4 hourly day 2, 6 puffs 4 hourly day 3 and so on and so forth.

I think that although your son seems better today it would be worth making an appointment with the GP to get his chest listened to and oxygen saturations checked.

[SweetTeaVodka]

The paediatricians I work with rarely give a formal diagnosis of asthma under the age of 5 as childhood wheeze is very common and most children will outgrow it. Obviously some children will unfortunately be a lot more severely unwell and may then be diagnosed as asthmatic young.

However, asthma and childhood wheeze are treated exactly the same way, so whether or not you have the label at this point doesn't make much difference.

[SweetTeaVodka]

These are the leaflets we give out at my hospital to reinforce the advice we give about using the inhalers, may be helpful for OP or other readers:

www.medicinesforchildren.org.uk/salbutamol-inhaler-asthma-and-wheeze


www.medicinesforchildren.org.uk/beclometasone-inhaler-asthma-prevention-prophylaxis-0

Asthma UK is another great resource with lots of easy to understand info about diagnosis, treatment and management of attacks in their advice section. As I said earlier, asthma and childhood wheezing are treated the same so the same advice will apply.

(Sorry for any cross posts that may have occurred, it took me forever to copy and paste the links on my phone!)

[MNerAnon]

Thanks all. It's been helpful to know the inhaler isn't being used properly and that he needs further review. I've contacted the surgery, especially necessary as he now cries when the cough hurts each time. It's he sort of cough that is dry and sharp but wet at the same time and he can't clear any secretions.

[Gileswithachainsaw]

I hope they cab see him today he may need some pre, or to check he's not git a chest infection. after last might I'd really get him seen

[Gileswithachainsaw]

some pred