When is nebuliser needed for asthma

[Frankie473]

My son is on oral steroids to try and get asthma cough under control. Oxygen is 98% so good. Cough no better since starting steroids yesterday and looks awful. Do we leave it longer or go to A&E? Not particularly breathless just can’t stop coughing .

in an emergency, if you are struggling to breathe and need a high dose of your reliever medicine - paramedics or hospital staff may give you reliver medicine through a nebuliser. at home if your condition is very severe, and you are unable to use an inhaler or inhalers are not as effective as nebulised medicine.

on the Asthma U.K. site
www.asthma.org.uk/advice/nhs-care/emergency-asthma-care/nebulisers/#Whenused

But if you’re having a severe attack, you may be given rescue medicine through a nebuliser instead. This is so you can be treated quickly with high doses of medicine in an emergency.

Young children, or people who cannot use an inhaler and spacer well, may be treated using a nebuliser even if their attack is not considered severe.

Thanks. I’d read that but wondered if peoples experiences were actually different

If he can’t speak a sentence without coughing then he needs additional medical help. I’d ring 111. It may be that he actually needs antibiotics as well as the additional steroids.

Is he using his blue inhaler through a spacer?

We’ve moved away from home nebulisers as generally speaking if you’re unwell enough to need nebulising, you need to be in hospital.

thanks everyone for feedback. I’m waiting for call back from 111. Yes he’s using a spacer. He can talk some sentences without coughing but it’s pretty much continuous . Gets relief for about 10 mins from inhaler.

My dd has asthma. She's a teenager now and it's well controlled but when she was younger we were told that if she was unwell enough to need a nebuliser then she needed to be seen by a doctor.

Just go straight to A&E, take your phone in case 111 call on the way.

My issue is not knowing what happens next and if he is needing a nebuliser as we are new to asthma . Hopefully 111 will call back soon.

His oxygen is fine and he’s not struggling for breath. Just can’t stop coughing. If he was struggling to breathe I’d be at A&E.

Has he been told to take 10 puffs of the blue? That's the equivalent of the nebulisers and will help. In this situ, my asthma presents as a cough too. How long has he been on steroids.
It normally takes a few days after stopping that the cough goes for me. Good luck

He’s taken 2 days of oral steroid. I’d read about 10 puffs but not been told to take it. Thanks

You should be advised to go to a&e if he is needing 10 puffs or if you are having to give it every 10 minutes. Partly because its not relieving his symptons but also the reliever will raise his heart rate so he needs to be monitored if he is having high dosage.

Also, just to say sometimes kids don't present with classic wheeze/breathlessness. My DS has never had a wheeze. We know his various external signs now but had no idea when he had his first attack at 18 months until the paramedics looked at him and recognised it straight away.

You say he isnt breathless but what does his breathing look like?
Is he drawing his breath up under his ribs rather than his whole belly gently filling when inhaling? Is he drawing his shoulders up when inhaling, or do his neck muscles look tense, or shouldrrs raised? Those would indicate he is struggling, but regardless, if the blue isn't relieving symptoms then i'd go to A&E.

2 weeks post covid my 5yr old woke up and was wheezing and coughing and only able to speak a few words. His Sats were 83, 111 said there was an hours wait to speak to anyone so we went straight to A&E. He had 3 nebulisers and then was sent home on steroids.

If the ten puffs doesn’t significantly help, I’d go to A&E. You don’t want to mess about with asthma.

Here mentions the ten puffs if you’d like to read up on it. It also says about constant coughing.

www.nhs.uk/conditions/asthma/asthma-attack/

Thanks everyone. He’s had 5 puffs as I was a bit worried about his heart rate with 10 as it’s been a bit high today. It’s calmed the cough a little but still there . Will wait and see

Hi, how old is he? What dose of steroids is he taking, if he's on the maximum dose and inhaler only giving temporary relief I would get him checked out tonight.
I don't mean to be alarmist but I found I always needed further treatment if my reliever inhaler only gave short relief of my cough. When I was younger a cough was my main symptom, I didn't really wheeze, but my oxygen levels would suddenly drop.
Now it's much easier as I have such a loud wheeze along with a cough I know when to seek help. The relief that a nebuliser gives is amazing, hope your DS feels much better soon x

He’s 17 and on 30mg of steroids for 3 days- today is day 2. He says his chest feels much less tight now after 5 puffs and he hasn’t realised it was tight. We are new to asthma so appreciate the help . I’m not ruling out A&E yet.

Just be aware that some people never “wheeze” - I have cough variant asthma and if I’m coughing it’s the equivalent of someone else having a full blown attack. If he starts coughing again I do think you need to see someone. The main symptoms I have of an attack coming are chest pains and feeling just “off” and the coughing is when it reaches an acute point.

DD’s care plan says 10 puffs of salbutamol (it does raise her heart rate a fair bit) and if not relieved, A&E. If 10 puffs relives, but she can’t go for 4h without a further dose, A&E
Also A&E if her sats (awake) are below 95%
And echo to observe his breathing
The oral steroids should have made a significant difference by now
if you’re not sure, better to get him checked out in A&E, they never, ever mind seeing someone with breathing issues 🌸

He can have 10 puffs through a spacer, don’t worry too much about the heart rate as the salbutamol will elevate it slightly and could also make him feel a bit trembly, but the benefits will be worth it.

Just to add, medics are very happy for lots of puffs of the blue. Don’t feel you need to be sparing with it. Do the ten puffs and if that is not significantly better after a couple of minutes then it’s fine to do another ten.

Please listen to people saying this could be classed as an asthma attack and treat it accordingly. I see you’re not ruling out A&E, so I’m not meaning to tell you off, just reinforce what’s been said before. Good luck.

Same here (uh, high five?)

Also, OP, be aware that many doctors won’t know this and will dismiss it as “just a cough”.

From what you’ve described he must be feeling rubbish. For me at least, the coughing doesn’t feel like a normal cough when you have a cold or a tickle in your throat. I’m really struggling to breathe and it feels awful. My blood oxygen stays high but it’s not at all like a viral cough where you just have to let your body fight it off. I’d push to get him seen asap, mainly because you are likely to get fobbed off due to the coughing.