Blue inhaler question (salbutamol)

[flowergirlso]

Has anyone ever heard of a doctor advising to use the BLUE inhaler morning and night every day??

my 3 yo, who gets croup often and has had a asthma sounding cough has been instructed to use blue inhaler morning and evening, every day.
we’ve been doing it the last couple of weeks and no longer has the asthma sounding cough.. but I’ve never heard of the blue one being used twice a day only as and when needed?

i did query this with the doctor and said should this not be the brown inhaler? And he said no, he meant to prescribe the blue and give these instructions

just wondered if anyone has ever been told the same

No, but we have been advised for DD to take the blue one at regular times during periods of illness. Not on a permanent basis though.

The blue one should only be used if he's wheezing. Strange advice from the doctor.

Hmm.. I think I’ll do an econsult tomorrow and ask for a second opinion. I feel bad that I’ve done harm by giving it twice a day for the last couple of weeks now :( it’s been so hard to get any help with reoccurring croup symptoms and the cough. He was already prescribed the blue inhaler ages ago, to use and and when needed, then prescribed again on this basis.. which didn’t seem right so I queried and was made to feel a bit silly for asking. But I’ve done so much research and can’t seem to find anything about using the blue one every day

It's in my DD's asthma plan to do this as soon as she has a cold/other virus to try to prevent her ending up on yet more oral steroids. So maybe this is more what they meant? Using it morning and night if they have any symptoms/ a cough.

No one should just be using a blue inhaler alone anymore. New guidelines came out November 24 from NICE etc all saying the same thing. There is a little more flexibility for adults with use of a combined inhaler and different regimes but young Children should have an inhaled steroid alongside twice a day with the blue as needed. If needed more than three times a week they are not well controlled.
Is your child using a steroid (preventer) at all??
The old advice of using a blue inhaler twice a day prior to the brown is very outdated advice.
Practice nurse.

It may be an age thing. I remember my son picky got a brown inhaler when he was about 11 I think. He was hospitalised twice between 7 and 11, and used the blue quite regularly. Maybe it's an age thing? If it's been working, then I guess the doctor is right to prescribe like this just while he has the croup.

Croup is due to inflammation of the airways. A blue inhaler does nothing to treat this, it simply opens up the airways temporarily providing short term relief. Inhaled steroids dampen down that inflammation.

Thank you so much! That’s super super helpful. Well it’s been two weeks now, and he’s not getting the coughing in the mornings like before so I’ll stop using it and see I guess. He does need oral steroids when he has croup, but that can come out of no where with no warning. All I’ve ever been told is to take him up the hospital for steroids and he will outgrow it..

thank you so much for the clarity on the change of guidelines. My son doesn’t have a steroid inhaler at all no. I’ve pushed for one, as I think it’s needed but it just seems to be a struggle to get anyone to listen :( I just get told he’s only 3, they can’t diagnose asthma and he will grow out of it. But doesn’t change the fact he gets croup every 1.5-2 months, needing steroids 90% of times he gets it, has symptoms of mild asthma.. honestly just don’t know how to get anyone to help :(

MHRA guidance was published a few days ago to highlight NICE guidance etc to ensure short acting beta agonist (salbutamol) inhalers are never prescribed on their own without a corticosteroid inhaler. Worth a read and definitely check with another GP
or nurse at the practice. https://www.gov.uk/drug-safety-update/short-acting-beta-2-agonists-saba-salbutamol-and-terbutaline-reminder-of-the-risks-from-overuse-in-asthma-and-to-be-aware-of-changes-in-the-saba-prescribing-guidelines#:~:text=The%20guidance%20now%20recommends%20that,if%20asthma%20control%20is%20suboptimal.

Thank you, would explain why when he’s had croup I’ve initially used the blue inhaler in the past and it’s done nothing.
so the brown one would help prevent this potentially? As it’s something I’ve tried to push for before but was turned away. Just wondering if I need to dig my heels a little perhaps.. it’s horrible taking him up to a&e every 1.5-2 months for steroids for croup

See the practice nurse or ask for a respiratory referral.
I would suggest he needs regular low dose inhaled steroids via a spacer twice daily for now at least. With the frequency of use of the blue a guide as to how well controlled he is. This can be reviewed as he gets older with breathing tests and peak flow diaries etc to establish a diagnosis. A positive response to the blue inhaler is a good indicator in itself. Relying on emergency steroids month to month is crazy.
There are five deaths a day in this country from asthma and the vast majority are those of people only using a blue inhaler because it only treats the symptoms and not the cause.

Any child needing six lots of steroids in twelve months should be a big red flag!

My Ds1 recently ended up in A&E after an asthma attack and the doctor sent us home and said to take 7 puffs of the blue inhaler every 2 hours for 4 days. Including during the night. I thought at the time WTF? But thought the doctor knew best.

The next day he ended back in A&E as his heart was racing and he was white and floppy.

The doctor on duty THAT time was incandescent at the advice. And said that considering DS is also on ADHD medication (which i had been very clear about at the time) the advice was given was actually potentially life threatening.

In other words- sometimes the doctors fuck it up. And it is always always worth questioning something if it simply does not sound right.

It’s worth keeping in mind that a lot of the guidance being quoted is for asthma, and there are other reasons for blue inhaler use that aren’t asthma.

Pharmacists are good sources of knowledge on appropriate medication use, and generally have good communication routes with GP practices and are often more up to date on prescribing guidelines. May be worth going to yours to have a chat.

Thank you so much for this. I’ll do this right away tomorrow.. honestly I’ve pushed for ages now. Every visit I’ve questioned and been told the same thing that he will grow out of it, and nothing can be done, I just get made out like I’m worrying about nothing!! It infuriates me.

i would say he’s definitely had at least 4 doses of steroids in the last year, a couple of the croup episodes weren’t terrible and controlled at home thankfully. But I said to the paediatric doctor, surely this isn’t right?! To which I was told ‘yep, just one of those things some kids just get it a lot’ :( my heart breaks for my son and myself and his dad are in constant fear the back of our mind..

im now scared to not give the blue inhaler in the morning in case he’s now relying on it and something bad happens? :( im definitely getting hold of the doctors surgery tomorrow.

thank you again

I was told when my DC was little that it's basically impossible to overdose on salbutamol, it does absolutely no harm if taken when not needed so if in doubt, give a squirt.

Agree that it sounds likely that he needs a steroid inhaler. You don't have to have been diagnosed with asthma to get a steroid inhaler. Recurrent viral induced wheeze and chronic cough toddlers quite often end up on steroid inhalers whilst waiting to see whether they grow out of it, or whether they go on to have asthma. Having said that, it won't help with true croup as croup affects the larynx, and salbutamol and beclometasone (the ingredient in brown inhalers) act on the medium sized airways in the chest.

Salbutamol raises your heart rate and when ds2 was having nebulisers when he had asthma attacks they had to give him potassium as it strips it out of the body, so I wouldn’t feel happy with the “can’t overdose” comment (I know that came from a health professional but they can be wrong).

ds2 had asthma triggered by chest infections, and no amount of daily brown inhalers would prevent an attack if he caught a bad cold.

he’s in his 20s now and finally grown out of asthma, but he was never taking his blue inhaler unless he was wheezy (occasional post exercise, plus the fore mentioned colds) and if he needed it too many times in a day I was told to bring him in to a&e.

Edited to add that it was his asthma nurse who would do reviews of his treatment as they are specialised and often more knowledgeable than the GP.

Blue inhalers shouldn’t be used alone, and in under 5s the guidance is - when asthma is suspected - to trial an inhaled steroid (brown one via a spacer) for 8-12 weeks.

Salbutamol can be used for croup but is unlikely to be significantly beneficial and steroids are usually indicated even if just a stat dose. Dexamethasone should be given rather than prednisolone.