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Original poster

When is nebuliser needed for asthma

52 replies

Frankie473 · 21/02/2023 17:22

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 .

OP posts:
Original poster
Frankie473 · 21/02/2023 21:09

My hesitation is that he doesn’t have breathing issues and no diagnosed asthma yet as this is only the second time we have had the coughing attacks . He’s still coughing but sats are fine. He doesn’t want to go to A &E as says they won’t take a cough seriously . Would be easier to know what to do if diagnosed asthma.

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FawnFrenchieMum · 21/02/2023 21:10

@CatNamedEaster & @WorriedMillie have both given the advice I would have done from my experience.
I judge by both the looks / type of breathing (especially the breathing under the rib cage) and the 10 puffs parts / under 95 oxygen.
His oxygen does sound ok for now though.

FawnFrenchieMum · 21/02/2023 21:12

Both my children’s asthma displays as a cough, so they would take that seriously but I think based on the 98 oxygen they wouldn’t nebulise. I’d probably wait for 111, and ask for out of hours. He may need anti-b’s.

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Bekindbekind · 21/02/2023 21:14

Frankie473 · 21/02/2023 21:09

My hesitation is that he doesn’t have breathing issues and no diagnosed asthma yet as this is only the second time we have had the coughing attacks . He’s still coughing but sats are fine. He doesn’t want to go to A &E as says they won’t take a cough seriously . Would be easier to know what to do if diagnosed asthma.

I absolutely see your point.

Please note that the cough IS the breathing issue (as I said, plenty of medical professionals don’t know this).

I’m curious about how he has meds without a diagnosis. Has he had spirometry done? I understand that you probably don’t want to have this discussion at this moment so feel free to ignore. I was diagnosed with cough variant asthma as an adult, hence my questions/attempts to help.

Original poster
Frankie473 · 21/02/2023 21:18

He had this cough a few months ago so gave inhalers but was better with brown inhaler in few days. Stayed on brown inhalee and then came off as advised by Gp to see what happpened. This cough started on Friday and got oral steroids yesterday after inhalers weren’t working. Have been given peak flow to record for 2 weeks.
eyes and nose are now streaming but not a cold - literallly like tears . V strange .

OP posts:
Bekindbekind · 21/02/2023 21:25

Frankie473 · 21/02/2023 21:18

He had this cough a few months ago so gave inhalers but was better with brown inhaler in few days. Stayed on brown inhalee and then came off as advised by Gp to see what happpened. This cough started on Friday and got oral steroids yesterday after inhalers weren’t working. Have been given peak flow to record for 2 weeks.
eyes and nose are now streaming but not a cold - literallly like tears . V strange .

I’ll stop hogging your thread now but I have exactly the same with streaming eyes and nose. Was at the specialist last week and it was like I had a cold… everything gets irritated and inflamed. I now have a nose spray (anti-inflammatories) as well as the other meds.

I’m non-UK so things may be different there but to test for asthma they can give you a peak flow test, then salbutamol, then 15 minutes later another peak flow test.

Poor kid, I hope he’s feeling better soon.

ijustneedanamefgs · 21/02/2023 21:26

I’m severe asthmatic. Is the inhaler relieving him? And how long is it lasting? He can keep taking it. It can make his heartrate faster, that’s pretty normal tbh. Having the nebuliser on top of it will increase that. Your salbutamol inhaler is the same as is put in the nebuliser, though they can put a different nebule in that helps open the airways, so if the blue isn’t working/lasting him then it’s worth getting this done. I have a nebuliser at home with both nebules. Do you have an out of hours as they will have a nebuliser there?
It’s only day 2 of steroids, they can take a while to work, you will hopefully notice an improvement tomorrow. Get them extended though, I never heard of a 3 day dose, normally 5 is minimum

Original poster
Frankie473 · 21/02/2023 21:27

You aren’t hogging thread. I really appreciate the information. A bit lost with this. Will see GP tomorrow morning and see if can get cough under control . Thank you

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ijustneedanamefgs · 21/02/2023 21:30

Don’t get caught up on the oxygen levels btw. I have had high enough oxygen and been really struggling and low oxygen and not as bad. He can have restricted airways and his oxygen still be ok at this time. Remind him to breath out also as often when you are struggling you take so many deep breaths in and forget about breathing out.

Original poster
Frankie473 · 21/02/2023 21:30

The inhaler stops the cough for a few minutes at a time. It’s literally non stop. Oxygen still ok though . I wondered if a nebuliser would open airways to stop cough. No doubt 111 will call back in middle of night 🤣

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Flossiemoss · 21/02/2023 21:31

Oxygen levels are the last thing to drop with asthmatics. If he can’t talk in full sentences and steroids have not kicked in sufficiently then yes I would take him to an and e.

ijustneedanamefgs · 21/02/2023 21:33

Can he talk ok? I think the cough will just improve as he does tbh. Also the cough could be his asthma or could be an illness which is causing his asthma to worsen.

Original poster
Frankie473 · 21/02/2023 21:34

He can talk. The cough is the asthma as he isn’t ill. This is day 5 of this cough .

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ijustneedanamefgs · 21/02/2023 21:38

Bless him, it’s a tough scary illness. If in doubt I would just take him. They will take him seriously, asthma is serious. I do think you might notice a difference tomorrow though, those steroids are little magic pills. Definitely get them extended though as you should still have them a couple of days after you are well improved and he’s obviously not.

Wearpantsffs · 21/02/2023 21:39

Hi there - I’m a respiratory specialist nurse.

My advice is to take him to A&E. Coughing continually as you describe is an asthma attack. Please give him 10 puffs of his blue inhaler through his spacer (1 puff, wait 30 seconds then the next 1) and then pop him in the car.

o2 sats are not meaningful in asthma. By the time they drop, a person is in serious trouble. A better guide is if 2 puffs of the blue reliever inhaler is not lasting 3-4 hours.

he is also on the wrong dose of steroids - should be 40mg not 30mg.

Wearpantsffs · 21/02/2023 21:40

I’d also advise ringing into the Asthma and Lung UK helpline tomorrow, once you have got him sorted. The nurses will talk it all through with you.

Original poster
Frankie473 · 21/02/2023 21:41

Thanks. I did call asthma uk today but couldn’t speak to anyone . Was planning on callling them tomorrow.

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Wearpantsffs · 21/02/2023 21:42

Good plan!
but please do take him tonight. Asthma is invariably worse at night so I think it’s inevitable you’ll end up there…you may as well go calmly now than in a panic later.

MeinKraft · 21/02/2023 21:51

WeCome1 · 21/02/2023 20:43

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 for this link. My 5 year old has just been given a blue inhaler for a constant unrelenting cough. He has been coughing much more than a child normally would for a couple of years now but it's got much worse this last few weeks. Anyway I didn't realise before reading this link that children can complain of stomach pains with Asthma- he does quite frequently suffer with tummy pains, poor thing.

christmashilly · 21/02/2023 22:00

Xrays · 21/02/2023 21:01

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.

I am the same my asthma presents as a cough my last attack where I needed nebulising my cough was constant and I could speak a whole sentence without feeling breathless and coughing, I was treated as an emergency. I don't have wheezing and my oxygen stats were 98% I was still having an asthma attack that couldn't be controlled at home. My doctor sent me straight to A&E and they told me that oxygen doesn't always drop in all attacks.

goingtohellinahandcart · 21/02/2023 22:18

I would take him in, he sounds very much like my dd1, her oxygen stats are nearly always around 98 even when she can hardly talk or can't stop coughing. The effort from coughing or trying to breathe can exhaust them.

PearsOfWisdom · 21/02/2023 22:27

I have asthmas as does my 17 year old son. The usual dose of prednisilone we get is 40mg for 5 days, not 30-mg for 3 days.

Also what preventer inhaler is he on ? If he is that bad Id have thought he would be on pink not brown .

( disclaimer - Im a patient not a HCP)

JenniferBarkley · 21/02/2023 23:02

I have asthma and have never had to go to A&E with it, I've always been able to manage it at home and through the GP - I think you should bring him. You don't fuck around with uncontrolled asthma.

Original poster
Frankie473 · 22/02/2023 01:07

Thank you for all your help. Went to A&E. Gave him antibiotics, increased the oral steroid and now on a nebuliser. Hoping it will sort it out.

OP posts:
SoonBeTeaTime · 22/02/2023 01:36

My 5 year old gets coughs that go to his chest quite often in winter months. We only go to a+e if he is struggling to breathe, can't speak and the blue inhaler won't work (after 10). He hammers it when he's poorly every hour or so sometimes. When he has been taken to a+e with it they've given him a couple of nebulisers but then just hammered the blue inhaler as part of the treatment, my husband said to me when they were stuck on the children's ward for 2 days what's the actual point, they are just hammering the blue inhaler like we do at home. We only go to a+e now if the inhaler doesn't relieve symptoms at all. If oxygen levels are 98 I wouldn't be concerned at all in fact that's perfectly normal, when my 5 year old has been in poorly they dip into the mid 80s and don't come back up with the inhaler.

I've always been surprised how blasé they can be whenever we've gone to a+e (especially with a child aged 2-4 fully fighting for breath, sats in the 80s), granted we've never had to wait when we've got there, but they always seem a bit meh. I can't imagine them being bothered in a+e about someone coughing with normal sats, maybe if their breathing is really laboured, but just coughing I wouldn't take my child personally and mine is only little.