Salbutamol - bottoms up!

[Mrs. Robinson]

Got a script the other day:
Salbutamol 6 puffs four times a day (doctor confirmed it on the phone).

I wonder if you come across such a dose from time to time.

[silnarnin]

I've seen two puffs up to ten times a day.

[richtagg]

I've seen much larger doses of salbutamol than this.

You need to consider what the patients treatment is for and whether they need the rest of their medications reviewed, do they need to be stepped up the BTS scale if they have asthma?

You should also talk to the patient about their inhaler technique.

[Pharmanaut]

Originally Posted by richtagg

I've seen much larger doses of salbutamol than this.

You need to consider what the patients treatment is for and whether they need the rest of their medications reviewed, do they need to be stepped up the BTS scale if they have asthma?

You should also talk to the patient about their inhaler technique.

Have they developed 'test firing' paranoia?
We had one old lady who like to test fire her inhaler every half-hour or so, in order to make sure it had some left in it and that it would work. Needless to say the wholesaler delivery driver was kept busy.

Patient might also be frightened of 'steroids' having read the PIL, or has someones uncle had side effects?

How about a spacer device, an autohaler/easibreath type or a switch to dry-powder types.

[johnep]

Reminds me of the chap who used two glucose meters, in case one was wrong, and tested his sugar upto 13 times a day. Was having 10 boxes of strips at a time. naturally he was type 2 and when asked what he did with rhe results--answer nothing. No wonder cost of strips far exceeds cost of diabetic medication.
johnep

[Mrs. Robinson]

Thanks all for contribution to the issue. There was nothing to review, the patient hasn’t been on any other medication. I had a chat with him of course. But I have never seen such a script before.

[Mrs. Robinson]

And it wasn’t a repeat slip. He’s got it for the first time.

[Holly]

Sounds like a Rx for a COPD patient as opposed to someone with asthma.

Asthmatics shouldn't really be using their salbutamol more than twice a week (2 puffs each time) for breakthrough symptoms. If they are a review is probably in order.

[Sarah J]

In my hospital the paed doc's in particular are fans of 2-10 puffs as required, no matter how many times you question it, it never changes.

They tell us the patients are sent with a care plan that explains further but in three years I have not tracked one down

[SolomonQ]

2p qd is normal but with 6p, i would hope a long acting beta agonist as well as a steroid inhaler were also initiated, and as the 6 puffs need to be taken separately, this would take up alot of the patient's time, maybe affecting compliance!!!