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

[woopsiedaisy36]

Obviously can't go to the Gp as not open. He's had a bad cough all week, no temp or other signs of a cold. We've been on a caravan holiday this week though and the weather has been very cold and windy especially at night which is what has bought on his cough. Cough is always his worst asthma symptom at night. We usually always have a spare inhaler but because of the extra use this week it's run out. He's coughing non stop now and I can hear a bit of wheeze, is the best option our local minor injuries?

Thanks everyone. We've just got here so I'll see what they say. To answer some other questions he does have an asthma plan and takes monteslukast daily and a brown inhaler. He's only 5 so they are still figuring out what works for him but he has an appt with paediatrics next month as he regularly has to have steroids.

You’ve only just got where?

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

This happened to us on Boxing Day. Called 111 and had a prescription arranged within an hour to pick up from the duty pharmacy.

That’s a huge amount off salbutamol in one week. He may need steroid tablets to stabilise. Needs to see a doctor.

Because a pharmacist isn’t trained in asthma, can’t prescribe the necessary meds and asthma can kill very quickly and suddenly and you need to manage it properly. Another salbutamol inhaler isn’t going to treat the underlying causes.

Pharmacies
can’t
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emergency
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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?

He might need a change from steroid inhaler only to either a higher dose of the steroid inhaler and/or a combined inhaler - with long acting version of bronchodilator, which is what salbutamol is.

We got sent away as they won't deal with asthma apparently but they got us an appt with a gp out of hours at lunch time so hopefully we will get some help there. To those asking why I didn't just go to a pharmacy he has been using his blue inhaler non stop and it's not working so I think he probably needs someone to listen to his chest.

I agree with this. You can get an emergency inhaler from the pharmacy but if he is going through one in a week he really needs to be seen by a doctor. I’d take him in to A&E.

Which is why I said ‘first’, so that the pharmacy (or 111) can direct you as needed.

The OP was all about a replacement inhaler.

111
would
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Minor injuries won’t deal with asthma? Really? I hope the GP can help but I wouldn’t have been happy with that.

You are doing the right thing x

uncontrolled asthma is absolutely not to be messed around with

From your last post I would be more tempted to go straight to A and E if he is using it that much.

This

Urgent Treatment Centre, 111 Service or A&E

That's too much salbutamol

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.

Yes this sounds right to me - well done OP

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.

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

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.

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.

Just to update: we saw a dr who has given him a new blue inhaler but has also given him 5 days worth of steroids and antibiotics so hopefully that will help!

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.

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

OP, is he using his inhalers with a spacer?