Interesting...

This is a recent hot topic on Asthma UK and its something that I do find interesting myself. The subject is, of course that of the use of nebuliser therapy in the domestic setting. I myself am on home nebs and know many people who also use this therapy at home. However this is a quality of life thing, as without my nebuliser, I am pretty much housebound and unable to do the smallest things for myself.

I borrowed this from the forum, it was posted by Koolkat on August 3rd 2010.

"The 2008 British Guideline no longer recommends nebulised therapy for the majority of asthma care. It cites evidence suggesting that a spacer and metered dose inhaler (MDI) combination can be as effective, if not more effective, in many situations in which nebulisers were formally used. This includes both acute and stable asthma.

A spacer plus MDI is to be preferred because of the following issues:.

•More effective treatment with fewer side-effects because of better pattern of deposition

•Problems of poor inhaler technique largely overcome but spacers need to be used properly too

•Easily used by children and the elderly (except those with weak or arthritic hands)

•As effective as a nebuliser in treatment of acute attacks but light, cheap, maintenance free, portable and available on prescription

•Useful for treatment of first attacks of wheezing in patients who have not used inhalers before

•Useful for administration of bronchodilator when testing reversibility in the surgery to establish the diagnosis of asthma

•Reduced prescribing costs by basing treatment on the much cheaper metered dose inhalers

There are few cases in which the British Guideline recommends nebuliser use. It initially states that there are insufficient data to make a recommendation about their use in life-threatening asthma. However, later the Guideline does recommend that the nebulised route (oxygen-driven) is used for the delivery of high-dose beta agonists in acute asthma with life threatening features. Nebulisers have however certainly been used in this situation to deliver high-dose inhaled drugs. If a nebuliser is used in the emergency situation, there are theoretical risks of oxygen desaturation whilst using air-driven compressors. Therefore nebulisers should be oxygen-driven with a "high flow regulator" fitted to the cylinder in order to provide the necessary flow rate of 6 l/min.

Nebulisers are less useful for domiciliary management of stable asthma, but patient preference should be taken into account, and some patients - especially those with brittle asthma - may have more confidence in nebulisers than in MDIs. Such patients require a verbal and written plan for self-treatment and it is essential that repeated use of the nebuliser does not lead to failure to seek medical help and the prompt use of steroids."

I read this and found it interesting and got on to Google to look up the British Thoracic Society and their guidelines for myself. I found that the biggest worry of using nebs at home is that sense of security that even I will admit can be dangerous and you can get complacent about seeking help and thinking that just a neb would fix all attacks. I know this isn't the case with all attacks. I have had them and needed use of IV Hydrocortisone, Magnesium or even other therapies like Oxygen overnight so that I can recover. It worries me at the moment as so many people are currently asking about how to obtain home nebs, even though they are currently on quite small amounts of treatment as they are.

I was told that a nebuliser would only be considered at home when other options were exhausted, and we went about trying the other methods and medicines to help me overcome this. For 6 months, I had to play guinea pig, becoming inflated by steroids, taking other medicines to manage the side effects of the ones I take for my asthma. Then theres the change of preventor and protector. We tried so many different things that I was feeling like a human test subject, but because we were trying so many things, it lead us to verify what exactly we were dealing with.

Maybe what I am thinking is that rather than people asking for further therapy to be thrown at their condition, maybe they would be best finding out what it is that made them so ill in the first place, or maybe I have gotten the wrong end of the stick, but I agree with doctors who worry about the security blanket that these things can become.

Hoping you all are keeping well.

Wendy x