To go to minor injuries with DS's asthma cough as we have run out of blue inhaler?

Sitting up straight is better than laying down for asthma attacks.

You don't even need to call 111. It can be done online now. My pharmacy told me about this service and it was all sorted in 10 minutes.

https://111.nhs.uk/emergency-prescription

Sounds like he needs A+E.

Please call 999

If his oxygen level is actually 90% then A&E will put him on oxygen and give back to back nebulisers. If this is not a coughing fit, but a constant cough and the inhaler has lasted less than 2 hours, go to A&E.

90% needs reviewing tonight. Good luck

My advice would be A&E immediately. He sounds very unwell.

90% is definitely A&E territory but try not to panic as I don’t find adult oxygen monitors work well on small children.

But at this point I would be heading to A&E.

@woopsiedaisy36

I would call 111 to be sent to your nearest out of hours and get him checked.

If that amount of medication and steroids hasn't worked and he's using an inhaler that much without it working I would probably get him checked.

He may need to go on a vent system in the hospital.

Kids go down very quickly with things like this.

One of my now older dc were similar when they were very young

When you say ‘not helped’ can you describe his symptoms? Can he talk in a full sentence? What is his breathing rate? If you look at his tummy or neck can you see the muscles there working to breathe?

then a number of pharmacies in London must be misinformed as I tried to get salbutamol for myself from pharmacies and got told I had to go through 111 for an emergency prescription.
unless they don’t consider salbutamol a life saving med,,which would be ridiculous

Ahh yes,
Forgive me, I didn't read properly.
I think, in Paeds, its Montelukast first, then LABA.
Good he's getting a paed referral.
@Changeusernameseeusernamehistory

pootlin
You’ve only just got where?

I don’t understand why you wouldn’t go to a pharmacy first.

Pharmacies
can’t
issue
an
emergency
prescription
without
111

in any case, if he regularly needs steroids, they need to see a doctor.

@woopsiedaisy36 have you considered hay fever? Is he worse in places/times where pollen is higher?

Yes
They
Can

Read the NHS rules for emergency life saving medication.

OP, is he using his inhalers with a spacer?

He’s already on brown inhaler and montelukast. They’ll probably try him on a LABA steroid combination next but I don’t know if that’s standard escalation protocol in paeds. Needing constant courses of steroids is not good.

I actually thought the LABA steroid combined inhaler came before montelukast

I'm really pleased to hear that, OP.

Dig out that asthma management plan, make sure you've got a peak flow meter,( see he's only 5, but this can be an ideal time to get au fait with a PF meter, make it playful, ie, who can get the highest?....don't burst his bubble by blowing to the top, yourself!...)
Getting him used to and familiar with inhalers, spacers...( have you got one?) and peak flow meters will normalise what can become frightening and disrupting future scenarios.

He still young, so HCPs may be a little reluctant to formally diagnose asthma, but it is critical that you watch and be vigilant about how his symptoms behave as he starts school, especially, working with school to find out if he struggles ( ie, coughs, gets short of breath, wheezes, or simply flags) during PE, playtime, outdoor exercise).
Look hard at him at home too, during these activities because exercise and suddenly going out in cold air can trigger these symptoms.

Note how he is after a viral infection, especially cold. Very common to get residual inflammation that causes cough, wheeze, shortness of breath or fatigue after a cold. Nighttime cough is very persuasive of out of control asthma with attendant symptoms and history.
Do note that cough is often the only symptom of asthma; not necessarily wheeze.

With a peak flow meter, it would be great to establish his 'best', ie, measure it morning and night for 2 weeks, when he is well, so you can compare his 'best' measurement with when he demonstrates symptoms.

Do book him in to see an asthma nurse, so it is recorded on his notes that he has needed a 5 day course of oral steroids and to come up with a plan to review him.
He may need to start on a regular 'brown' inhaler in the future, to address ongoing persistent inflammatory airway constriction. But this will need assessment and recording of symptoms, possible peak flow measurement ( if he is deemed old enough) and the taking of a proper history and family history.

Well done, OP.
All the best....it'll take about 12-24 hours of oral steroids and you'll see a real relief of his symptoms. You'll both sleep better.

Using a blue inhaler "non stop" warrants and A&E trip (according to my 9yo's asthma plan she needs A&E if the maximum dose of 6 puffs every 4 hours isn't working!)

As you don't seem to want to do that then see the GP. I imagine they'll send you to A&E anyway as they tend to be over cautious with these kinda of situations - rightly so.

Sounds likes a GP appointment a few days ago could / would have negated things getting this bad but I personally think it's an A&E situation to get things under control. The GP may not be able to offer the level of medication and intervention needed.

Oh I agree it is a threatening emergency and have been to A&E myself with similar and been admitted. However, having a nurse or a paramedic onsite while waiting for emergency care is a lot better than sending a child away for a later GP appointment. So I suppose I’m critical of that.

In future call 111 first and they'll direct you to the appropriate service rather than wasting everyone's time.

Minor injuries unit around here is staffed by a paramedic or a nurse. They deal with bee stings, cuts, broken fingers and the like. They do a great job at what they do, but it’s a limited service that does what it says on the tin - minor injuries.

A child who is taking those sorts of quantities of salbutamol and “it’s not working” is not an injury, nor is it remotely minor - if it were my child in this situation and I couldn’t get an immediate GP appointment I would have them at A&E, it’s a potentially life threatening emergency.

Yes this sounds right to me - well done OP

I was going to say your should see someone if gone through that much blue. You can’t just use it endlessly without getting medical help for what might be an underlying cause.

My dd has asthma and generally needs pred by this stage.