Asthma Q: nebulizer vs inhaler

[truly scrumptious]

Rescue or preventative? We have been using a spacer plus inhaler for preventative meds since my twins were 20 months or so. When they are sick and really coughing a ton, we fire up the neb for inhaled Xoponex. For midday rescue puffs or rescue puffs on the go, we use the spacer. All research on neb v. spacer concludes that they work the same. Anecdotally, I disagree, which is why we use both.

Bubba Ray and others, including me, have posted about this topic in the past.

for us as well. We use the inhaler with spacer during the day (right before school, the school has one for during the day if needed, and /or right after school) but prefer the nebulizer with Xopenex at bedtime. Our pedi said that the nebulizer gives the meds a chance to really settle into the lungs and do their job, while the inhaler sends less meds into the lungs.
I agree with a PP who suggesting seeing if your insurance would cover a second nebulizer, and then do as we do and snuggle with a book or something while the neb does its thing.

[Simon]

We started an inhaler+spacer and mask at age 14 months with Ds2. At the time, it was taking 45 minutes per nebulizer session and as pp said we mixed the meds. Ds1 has an inhaler + spacer without a mask but Ds2 at age 4 still uses a mask.

We use it for both rescue and preventive meds. The main reason that some kids experience a difference with an inhaler (per our ped. pulm) is that it delivers more medicine than the 4-6 puffs of albuterol that are prescribed as "rescue" use. So not what Green_Tea heard about 4 puffs = 1 neb. We were told it may take 12-16 or more "puffs" delivered over 45 minutes to achieve the same dosage. We just keep that in mind and give 4 or 6 puffs, wait 10 min, give more as needed. We've never had to do more than 3 rounds of that to get clear.
ETA: When I looked it up online, it looks like the studies found that as many as 10 puffs of inhaled bronchiodialator were needed to equal a neb. treatment. Also, I am not trying to say that the neb isn't more effective for some kids. I totally believe you that it is necessary. I just don't want the OP to be afraid of trying inhaled steroids and to know that it may take more puffs to see the same results.

[Melaine]

For my kids and me....inhaler does nothing for rescue. Nothing. The neb really helps but I honestly just do the inhaler in desperation if we can't get the neb and I hope that it might at least have a placebo affect and help DD calm down if nothing else.

[egoldber]

If you are needing the rescue meds a lot, then it makes sense for the kids to be on a controller long term.

My older DD virtually never needs her rescue meds since she went on Flovent year round. In her allergy season, she steps up to a higher dose controller. Her asthma doctor says the goal now is to never have use rescue meds if at all possible.

She started using the spacer right away (around age 5) for her controller med. We have a nebulizer that we have used sporadically over the last several years, mainly when she has a severe illness. The nebulizer for her does work better for the rescue meds, but the way her heart races with the rescue meds we try to minimize it as much as possible.

[twowhat?]

Thanks, all! I'll call the ped today and see what he thinks. We don't use rescue meds often at all - this is the first time this year that we have needed to use it. Within a year we probably need to use it 2-4 times (all related to illness). Which I know is on the threshold for moving on to control meds so the ped is keeping tabs on us every 6 months to determine whether we need to step up to using daily control meds. But this thread gives me lots of good Qs to ask.

I myself use rescue meds related to illness 1-2 times a year. Every winter I get a cold that results in bronchitis and ends up with me needing antibiotics and inhaled corticosteroids in addition to my regular albuterol inhaler so I'm sure DD1 is going to be the same way.

[daisysmom]

We have worked with two different pulmonologists for our DD (7). One of them (well the nurse practitioner there) wanted us to use a nebulizer for albuterol. But after using it in their office and in doctors offices a few times, we have a kid that albuterol does not decrease the wheezing (at least to the ear of doctors using stethoscopes).

The other pulmonolgist (whose approach I like better) has told me that the inhaler with the spacer works just as well. She put us on a long term medicine (dulera) and at first we used the spacer with the mask (last year, so at 6 years old) which requires holding mask up to face for one minute. Much less time consuming. We have decreased that in strength and switched to flovent, and since then, decreased that in strength. At some point, maybe 3 months into it, this doctor got her just to use the inhaler with the spacer (so no mask) which requires just a deep breath in and hold it for 10 seconds.

I think you will honestly find that the internet reports and doctors vary on if the nebulizer or spacer works better. I do think that our second pulmonolgist was pretty clear that kids have to learn to do it right for it to work right, so she gave us a whistle to practice on so we don't have the mask now. All of this is much easier to travel with.