HOW much ventolin???

[bumperella]

My DD is 2.5 and has had 4 episodes of "viral wheeze" in the last 2 mnths. The first led to 4 nights in hosp on oxygen, the second to a brief daytime admission (14 hrs) the third to 2 nights in hospital.
This one we have "managed" at home using her salbutamol inhaler. 10 puffs every 4 hrs. It started at the weekend (doesn't it always?) I took her to GP on the Monday who wasn't interested, but did write a script for 2 more inhalers (each for 200 doses of 100mcg each). She was getting better by Friday last week (10 puffs every 6 hrs) and GP said she didn't need to see her again (I called for advice). She's since worsened and is on 10 puffs every 4 hrs again over the weekend and today. She had a hosp apt for an echo-cardiogram today and the dr at the hosp wasn't concerned about her breathing, and her heart looks "fine".
So she's had 10 days on ventolin thus far. To me, this is an insane level of reliever inhaler to be giving your child; I have asthma and I;ve nevefr had to take anything like that amount.
To the GP, there's no problem, her chest is "clear" so safe to continue with the ventolin. But I am finding it hard to believe that this is really the best/only thing to do.
Please come and tell me that as I don't have a medical degree I should leave it to those who do....?

I'm not sure I can be much help. My ds has asthma but it is fairly well controlled. The only incident where he needed lots of ventolin scared the life out of me. I rang the doctor and she said that he could have up to 6 puffs but anymore than that and he really needed to see a doctor quickly if it wasn't doing the job. I can't say if that's the general advice or just what the doctor recommended for my child, but the regular need for 10 puffs seems like a lot to me.

I vaguely remember the dr. saying that too much could cause the child to hyperventilate and exasperate the problem.

Not much help I know, but didn't want to read and run. I would seek further advice and maybe see the asthma nurse?

We have a leaflet which has 10 puffs, decreasing to 8, decreasing to 6 etc and advice that if you're then continuing on 2 puffs for more than 24 hours or if the weaning off isn't working (discounting any further triggers) to get further help.

In your shoes I'd be sat in A&E tbh. Either there's a problem physically or there is an environmental trigger which is preventing her from recovering. You need to work out what it is.

It's bloody terrifying and I'm astounded you're keeping cool after 10 days.

My understanding us that in an emergency you can give 10 puffs- 1 every minute whilst seeking help.

That amount regularly for a prolonged period won't necessarily do any damage but is not actually resolving the cause of the attacks

I would go back to the gp (see a different gp if at all possible) and insist on being heard....

My dc (and myself) have always been given other treatment when needing frequent reliever (and not that amount) .... It could be a steroid inhaler or - most often - a short course of steroid tablets to gain back control.

The side effects of that amount of ventolin also won't be pleasant - rapid heart rate, shakiness, possible muscle cramps....

I was a child

Sorry! Posting with sleeping baby on me...

Try again. I was a child like your daughter. I remember taking so much ventolin that I'd get the shakes. It was the only thing that made me feel any better. I was regularly on antibiotics and steroids, and these usually worked within about a day.

When I was hospitalised, I was usually given a nebuliser - which just contains a larger dose of ventolin anyway. I don't know what the answer is - this was just a fact of life for me every time I got a chest infection. It was always temporary, and did improve with age. It might be that a short and small dose of steroids would help, or a steroid-based inhaler to help prevent these occurrences.

It does seem alot, I would have thought there would be other options out there - even other relief inhalers that you don't need to take as often. Salbutamol is not the only drug available (although it is probably the cheapest).

I remember regularly taking 800mcg when I was a child, and while it did provide relief, the shakes I used get afterwards were not pleasant.

I think that you should go back to your GP, preferably another one, and tell what has been going on.

The risk is that there is an underlying problem, which can suddenly worsen and then these high doses of ventolin may not be enough.

How are her lips, nails, are they nice pink? Maybe do the nailbed test to see if she is getting enough oxygen ( it is also known as capillary refill test). How is her breathing?

If you are concerned tonight seek help, lack of oxygen is very serious.

Main side effects of high doses of ventolin are fast heart beat, tremors, feeling unwell, anxiety/panic attacks.

What's she taking as a preventor, if anything at all? 10 puffs every 4 hours isn't that unusual to be given as a dose after an admission to hospital but if she's been admitted 3 times in 2 months and is struggling again then I think you do need to look at using a preventor if you don't have one already. As a PP said you should be able to wean it down over time.

The dose of Ventolin won't do her any harm so I wouldn't particularly worry about that. Does your surgery have an asthma nurse? That might be better than the GP.

My son is a severe asthmatic - he was in HDU twice in 2 weeks. We have always been told that if he needs more than the 10 puffs in 4 hours then he needs to be seen in hospital right away - not to even bother driving ourselves and to call 999. Presumably so they can start nebulising him on the way.

He is allowed the 10 puffs and that is it but like a PP said 1 extra puff every minute whilst waiting for ambulance.

Has your child been prescribed a preventer? My son is on 2 preventer medicines and pretty well under control although I do have a big supply of steroids which we have been told to start using if we feel he needs it (his history of asthma attacks has unfortunately made us aware of exactly when he needs it and how much!)

No preventer; at the moment she's being referred for various tests, and I guess in the meantime the GP isn't willing to do anything more. I find it incredibly frustrating to be in this limbo, and was really questioning whether the GP was right in doing nothing except the preventer. Her colour is/was fine - laboured, rapid breathing but no blue-ness.
Her hospital admissions have always led to her being given a neb and oxygen as well as oral steroids.
She is much better today though, down to 8 puffs every 6 hrs, hopefully we can stretch that out a bit further to wean her off it over the next few days.

Glad you are managing to decrease it. TBH with DS I dont bother with the GP now, if we are worried it is straight to A and E (on the advice of his consultant) because GPs often miss things.

If it is ongoing I would push for a preventer inahaler at the very least.

If it helps though DS has 10 puffs of ventolin every day as standard and normally ends up needing another 5-10 during the day (he is just turned 4) he has in the past had 10 puffs every hour so the doses in themselves aren't something to worry about too much more that needing that much is an indicator things are controlled IYSWIM

it does seem rather a lot.
my asthma nurse said that if a reliever is needed for more than 3 days in a row, the brown inhaler in addition is needed.
go back to gp, maybe ask to be seen by the asthma nurse.

by the way the 10 puffs every hour was under close medical supervision. 10 puffs every 4 hours is like with others the indicator that A and E is needed.

Hi bumperella. As others have said, I think if she's needing that many puffs, the problem isn't under control. My dd2, now 16 months, has suffered from wheezing ever since having bronchiolitis at 8 months, spending a night in hospital on nebulised Salbutamol. We've been under a paediatrician, who's put her on Montelukast granules, and also a steroid inhaler, 2 puffs twice daily (Fluticasone). This regime has meant we rarely need to use Ventolin, and she rarely gets wheezy now. I wonder if this sort of plan could work for your dd? We were fortunate that the paediatrician she is under specialises in respiratory problems.

As others have said, you need to start a regular steroid preventer inhaler (usually 2 puffs twice a day). Salbutamol (ventolin) is a symptom reliever and you should only really use it occasionally if the steroid inhaler isn't doing it's job. You may also need a course of oral steroids to stop the wheeze. Once it's better, you go to just the steroid preventer twice a day and salbutamol (ventolin) only when needed, which shouldn't be very often.