brighid

I am not a medical professional either, but a life long asthma sufferer and honestly, this sounds quite excessive, especially for children. Perhaps in a status asthmaticus attack, but that truly requires immediate medical care (believe me, I have suffered from a number of these and nearly died on two occassions.) I cannot say that I have ever used any of my rescue inhalers that much, and if I felt I needed to I would be going directly to the hospital.

I would think that it should be taken one puff at a time, allowing time for the body to acclimate and then determine if another puff is needed.

Most often I only need one or two puffs off a resuce inhaler and that is usually right before exercise, or if I have come in content with an allergen that has penetrated my allergy medication defenses ... well this allergy season I seem to require more.

I have recently stopped taking Advair, an inhaled sterroid. I have had alot of success with it with few side effects, except weight gain and difficulty healing bruises or cuts. I have never breathed more freely, but have felt that the weight gain issue is simply more then I can take and my doctor has weaned me off it. I can already tell the difference in my breathing and use my rescue inhaler more frequently. I have had more success on Advair then I did on Asthmacord, as Asthmacord gave me near debilitating migraines.

Brighid

I

echidna

Yes, I had to earnestly question the 4 X 4 X 4 policy which they taught at the time, because I too was only taught a couple of direct puffs.

Puffs taken directly are far less effective than those through a spacer since without the spacer the powder mostly hits the back of the throat instead of reaching the airway. In fact the spacer is reportedly 7 times more effective.

Here's an Australian site with the following disclaimer :
http://www.parasolemt.com.au/Manual/asmtha.asp But treatment goes on ... I suppose one difference which I should have noted earlier was that the 4 X 4 X 4 treatment is applied after one has made the decision to intervene in an asthma attack, so presumably the patient is suffering or risking more than just discomfort.

Interestingly enough, it only lists 2 repeats of the 4 puffs. It's slightly different to how we were taught.

Jackalope

Gah, four puffs off a ventolin inhaler would give me serious heart rhythm problems. But even before I ever developed the arrhythmia problem, 2 puffs generally gave me the shakes. If I took the puffs too close together, I would sometimes get the shakes so bad that my teeth would chatter and I would stutter. So it's definitely a variable thing.

I was taught that if I could take two puffs, wait 10 minutes and if I was still having problems, take two more. If I was still having problems 20 minutes later, I should get myself to the ER. If I was having so much trouble I couldn't use the inhaler/spacer combo effectively, I should go directly to the ER. I'm also supposed to do my peak flow meter every night (I've been bad this week). If it's in my yellow zone, I'm supposed to call my doctor. If it's at the bottom of the yellow zone or the top of the red zone, I go to the ER.

At this point, I cannot take Ventolin or Serevent, which has been causing problems. I'm on oral steroids right now, on top of the Atrovent and Flovent. I'm now below the magic 15mg/day dose, and starting to have problems again. I'm also on Atarax (a very powerful antihistamine). Current protocol is to take 50mg of Atarax in the event of a bad attack. I'll probably ask my doctor about carrying a preloaded syringe of Benadryl again, given how bad this allergy season is already. My husband is on Claritin now, and having to supplement that at night with chlorphreneramine. And he used to only have very minor allergies.

Another thing all asthmatics should consider is carrying a sheet with them that has all their medications printed on it. Yes, I know your Medic Alert info also has that on it, but when you're in the ER and can't speak because you can barely breathe, the printed sheet is quicker. A friend who's a CNA, calls this a "freak out sheet." It goes with you to the ER so it can speak to the staff when you can't.

RoddyM

echidna might have seen some kind of a talking head on the 7.30 Report last week saying that the incidence of asthma seemed to be declining. He as good as said that the reason for this was that people were lately less inclined to believe and act upon medical opinion.

RoddyM

It's my opinion that many children learn to display symptoms that are successful in gaining the attention of their enemies.

SULPHUR

Ever had an asthma attack and thought youwere going to die?

brighid

Yes, and it's terrifying. Although when I had my two status asthmaticus attacks I was 13 and I really didn't KNOW I could die (don't ask me why ... but it hadn't dawned on me fully ... possibly due to lack of oxygen flow to the brain ... )

I have had some serious ones since and it was not fun. Thank goodness for in home nebulizers.

Brighid

yguy

I believe so - although it was never diagnosed as such. I saw that the fear would suffocate me, and when I let go the fear, the attack went with it.

echidna

This is worrying, particularly as our course was specifically taught in the knowledge that we will potentially treating kids as young as 8 years old. The course lists Australia as having the highest asthma incidence in the world & also touts Australia as leading the world in asthma treatment. I'm not so confident.

Unfortunately I missed that 7:30 report, RoddyM. The kids tend to monopolise the telly when I get home. I remember my own attack, it was so sudden I didn't even realise what was happening, just suddenly couldn't breathe. I doubled over for a few minutes but still managed to finish the race. A nasty experience, but relatively mild compared to some other attacks.

brighid

I concur. That dose for an 8 year old, who presumably never had an asthma attack before, is IMO startling. It's alot for a grown person who has taken these sorts of medication before. I would be interested to see the supporting medical literature for this 4 x 4 x4 procedure. I honestly can't remember ever taking 4 puffs within minutes of one another, more or less 4 more, etc. My son is 9 and has very mild asthma, mostly seasonal or aggrevated by a cold. He has seem to have (at least for now) out grown it. He occassionally needs a puff of an inhaler and does so through an aerochamber. Two puffs sends that kid on a roller coaster.

I am wondering if this 4x4x4 procedure is more like an emergency nebulizing treatment, in absence of an actual nebulizer. We have one at home and occassionally I need to use it (usually if I have an upper respiratory infection) and taking that extended dose of albuterol gives me the shakes no matter how many times I have taken it. But it also clears up whatever temporary difficulty I have if my rescue inhalers aren't doing the trick. I am glad I don't have to take it very often and actually the medication I was prescribed expired a while ago because I haven't had to use it in a long time.

Echidna, can you tell us any of the reasoning given behind this particular dosage and it's application?

Brighid