Any reason to limit the number of times DS uses nebulizer / albuterol?

[CharlotteMommy]

DS has had several incidences of severe wheezing in the past, and we are therefore the proud owners of a nebulizer, which we were instructed to use ongoing at the first sign of coughing. Our prescription of albuterol says to use "every 4 hours as needed".

Today we witnessed some pretty bad wheezing and labored breathing, and we probably used the nebulizer 6-8 times in a 12 hour time period. Clearly this is more than every four hours, and I was wondering if there is any harm in using it this often. FWIW, DS was given 2 breathing treatments, one right after the other, at a doctor's visit a few months ago.

TIA!! I appreciate the input.

[megs4413]

well, yes and no. Do I think your son is in danger from using so much albuterol? No, probably not (though you should check with your pharmacist for sure, because I'm not a doc nor do I play one on tv), but is it best practice to use albuterol that often? No, probably not. Some possible side effects: dry mouth, irregular heartbeat, seizures, insomnia, and nausea. Are you making sure he brushes his teeth after treatments? That would be a concern of mine as well. Additionally, there seems to be some connection to overuse of albuterol and progressively non-responsive bronchiodilation (sp?) in long-term asthma patients on albuterol. So, the more albuterol you have to use in emergency situations (like you're describing), the less effective albuterol will be for you over time to open up your lungs in an emergency situation. For this reason, many patients now use a "controller" medicine daily in order to lessen their dependence on "rescue" medications like albuterol inhalers and nebulizers.

I think your son would benefit from seeing a pulmonologist and getting a better care plan put together. a nebulizer 8 times in 12 hours for wheezing/cough seems a little reckless and silly to me. I would think oral steroids would help more. I hope he's feeling better soon!

[jren]

I would say that if you're needing to use it that much, then it's not really working and maybe it's time to try something different. Here's what we do: At the first sign of coughing, we start an inhaled steroid (Pulmicort) 2 times per day, with albuterol 2 or 3 times per day. If he doesn't improve, I'll add Singulair, and if still not improving, I call the doctor and we get an Rx for oral steroids. We continue ALL with the oral steroids until the cough is gone and then wean off in this order - Singulair, albuterol, Pulmicort. So, I drop albuterol before Pulmicort b/c I find the albuterol is just not that effective (and has more side effects for us).

[Kindra178]

If you need a rescue inhaler that much, it's time to use a steroid preventative inhaler, or Singulair, or both. My three boys do both. They use Flovent. By using a preventative system, they usually don't get in terrible trouble when sick. Similarly, I use Advair. When I don't use it regularly, when I get sick, I tend to wheeze more and for longer periods of time.

As for using the neb that much in that short period of time, yes, that is harmful. It could cause a person's heartrate to skyrocket, or seizures. Our ped told us that if we need to use the neb more than every four hours, we need to go to the ER. All that said, at my ped's office, they often neb a wheezing child twice in a row if they are not able to hear the lungs.

[ett]

As for using the neb that much in that short period of time, yes, that is harmful. It could cause a person's heartrate to skyrocket, or seizures. Our ped told us that if we need to use the neb more than every four hours, we need to go to the ER. All that said, at my ped's office, they often neb a wheezing child twice in a row if they are not able to hear the lungs.

I agree. We've done the neb twice in a row at the peds office and they will do it more frequently at the ER, but those are situations where doctors are supervising. Please do not use the neb that frequently at home. 6-8 times in a 12 hour period is much too frequent. If he's really having problems breathing, you need to go to the ER.

He may also need to be on a preventative steriod daily like pulmicort or flovent so that the wheezing is not so bad when he gets sick.

[CharlotteMommy]

Thanks for the input everyone. DS is doing much better today and we only used the nebulizer with him three times throughout the day. Coincidentally, my DD has a well check appointment scheduled for this Tuesday, so I'll use that as an opportunity to discuss DS's nebulizer / albuterol usage with our ped as well. Thanks again for the information!

[Dr C]

You might consider making an appt for your DS as well so your doc can check his lungs and you can discuss whether he needs an everyday controller medicine (like flovent or pulmicort that PP have mentioned).

[nfceagles]

It sounds like the worst has passed for you, but I wanted to agree with pp's. I've never had to take my child to the ER for his asthma, but if he wasn't responding to albuterol and needed it that often, we would definitely be at either the drs office during hours or the ER if after hours. He needs oral steroids and medical attention if the albuterol isn't enough.

[wildfire]

I agree with everyone else. If the albuterol doesn't control it for 4 hours and we need to redose before then, we go in to the doctor for a check. It usually ends up in oral steroids to get the breathing under control. If it is 3 1/2 I might wait and see if it is after hours, but for every two hours I would definitely be going to get a lung check.