Guest guest Posted November 24, 2005 Report Share Posted November 24, 2005 To neb or use a metered dose inhaler with spacer....that is the question!!! Evidence says: MDI with spacer is AS EFFECTIVE OR BETTER than neb. There is better particle deposition. 24 puffs is about 4 single strength nebs give or take so that really is not soooo excessive. As for IV solumedrol versus oral, there is some evidence that IV works faster because it by-passes the GI system. However, if you are not in status asthamticus, can tolerate oral intake, PO (oral) will work prefectly fine. In Montreal, we get a combo of both depending on your status and the RTs. RTs give nebs so if there is a trauma or major other case, you could get lost in the shuffle so being on puffers gives the patient and nurse more control. That being said if you are too exhausted or too tight to use an MDI, nebs could be better. The SARS issue is salient too since there is now increasing concern about the spread of nosocomial infections. In Montreal we had the collective freak out back in the day too but the hysteria over it has died down. Oh yeah, routine use of antibiotics in acute asthma is not indicated in the Canadian concensus guide for asthma management unless there is evidence of an infection (ie on xray, blood work or if the pt has a fever). It really is an issue of cost effectiveness of treatment. Sure it seems like Canadians practice third world medicine but keep in mind this is socialized medicine. Everyone is covered, frequently meds too. In my case, my drug insurance coverage costs me 200$ a year and I get my 40,000$ of meds a year no questions asked, just send us the bill. So there are pros and cons to both systems I think. Your views? __________________________________________________________ Find your next car at http://autos..ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2005 Report Share Posted November 24, 2005 I agree with your views ! I've asked healthcare professionals about neb vs. MDI with spacer and they all agree that it is as effective. I didn't know what the comparison in the med received from 24 puffs of Ventolin. Good to know!!!! On the down side, I went back to my family dr. yesterday. She is not happy as my peak flows are still around 320 with all the meds and she can't really hear anything on inspiration. We know I'm breathing!!! I am now up to 75mg prednisone and she took me off the symbicort and put me on serevent....plus the ventolin/atrovent still at 2 puffs qid. On another side as well, I work for a lawyer. She said that if my husband's insurance company turns me down and denies an appeal, she is going to approach a lawyer/doctor she heard lecture a few years ago. Apparently he advised that you can ask/appeal OHIP (Ontario Health Insurance Plan) for meds that will improve the quality/longevity of your life if you can not afford them. It is another route open to me! bye for now. Pamela Kingston, Ontario > > To neb or use a metered dose inhaler with > spacer....that is the question!!! > > Evidence says: MDI with spacer is AS EFFECTIVE OR > BETTER than neb. There is better particle deposition. > 24 puffs is about 4 single strength nebs give or take > so that really is not soooo excessive. As for IV > solumedrol versus oral, there is some evidence that IV > works faster because it by-passes the GI system. > However, if you are not in status asthamticus, can > tolerate oral intake, PO (oral) will work prefectly > fine. > > In Montreal, we get a combo of both depending on your > status and the RTs. RTs give nebs so if there is a > trauma or major other case, you could get lost in the > shuffle so being on puffers gives the patient and > nurse more control. That being said if you are too > exhausted or too tight to use an MDI, nebs could be > better. > > The SARS issue is salient too since there is now > increasing concern about the spread of nosocomial > infections. In Montreal we had the collective freak > out back in the day too but the hysteria over it has > died down. > > Oh yeah, routine use of antibiotics in acute asthma is > not indicated in the Canadian concensus guide for > asthma management unless there is evidence of an > infection (ie on xray, blood work or if the pt has a > fever). > > It really is an issue of cost effectiveness of > treatment. Sure it seems like Canadians practice third > world medicine but keep in mind this is socialized > medicine. Everyone is covered, frequently meds too. In > my case, my drug insurance coverage costs me 200$ a > year and I get my 40,000$ of meds a year no questions > asked, just send us the bill. So there are pros and > cons to both systems I think. > > Your views? > > > > > > > > > __________________________________________________________ > Find your next car at http://autos..ca > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2005 Report Share Posted November 24, 2005 When I use an inhaler, it always makes me worse, even when I use a spacer. My doctor says that I am allergic to the propellent. I have to neb. I have a regular sized neb machine at home and have a portable Omron batrery/wall plug/car plug nebulizer that I take on the road or in the car. (See picture in the picture area of this group) I have only been hospitalized 2 times for asthma. The first time was 4 years ago before Xolair was available. I overdosed myself on Albuterol by nebbing every hour or so. I just could not get any relief. I had a panic attack and was shaking like a leaf. The ER was in a small county arkansas hospital. The doctor nebbed me with Xopenx (I had never heard of it before) and then gave me a shot of Valium. Within 10 minutes, I was relaxed and breathing down to my toes. She discharged me the next day with strict instructions to see my allergy doctor. The 2nd ER visit for asthma was in June 2005. I was on pred, but evidently it wasn't enough. I had another panic attack and overdid my nebbing. This time, I was in a medium city's hospital. The doctor there gave me a dose of Xanax to calm me down and immediately put me on an IV with solumedrol for 12 hours. Within 30 minutes, I could breathe much better. Also, my doctor put me on 2.5 mg of Glyburide to keep the prednisone from raising my blood sugar off the scale. As for payment for my treatment, I have good medical insurance that paid 90% of the cost. Oh yes, I pay 12k a year for that coverage too! Just a couple of more stories from the ER (Hmnmmm, isn't that a tv show or something?) Doug Group founder Co/owner and moderator Quote Link to comment Share on other sites More sharing options...
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