Why does Ventolin never help me?

That’s a question from my search-engine list. First of all, a little information. Ventolin, the brand name of the Salbutamol inhaler, is the gold standard for inhalers. It is used in hospitals for spirometry testing, and for the more complex Pulmonary Function Laboratory tests.

The way to tell if Ventolin really isn’t helping is to get your doctor to run a spirometry test before and after using your inhaler, bearing in mind that you need to wait 20 minutes after taking it, or use your own peak flow meter.

There are several reasons why Ventolin may not help, not the least being misdiagnosis of asthma.

Then there’s the question of how it’s used. Ventolin is intended to be used “on demand” to relieve an asthma attack, but it also has a prophylactic effect – that is, it can be taken in advance, to prevent an attack, especially in the case of exercise-induced asthma. In either case, one or two puffs is the normal dose. If that doesn’t work, though, you will come to no harm whatsoever taking another puff or two (I frequently take up to six, using a spacer device). It’s impossible to o-d on a Ventolin inhaler – compared to the dose obtained via a nebuliser, the dose from an inhaler is minute.

Bear in mind that, no matter whether it’s taken to relieve or prevent, Ventolin takes up to 20 minutes to reach its full effect. It does NOT work instantaneously. It should also, whenever possible, be taken using a spacer, the Volumatic device being the best.

Some doctors place too much faith in inhalers – I believe they should be used as adjuncts, rather than as the primary drug, as in my drug regime . And Ventolin, which is quick-acting but relatively short-lived, may need the support of one or more bronchodilator or steroid inhalers.

I have 4 inhalers, three bronchodilators, including Ventolin, all of which work in different ways for different lengths of time, and a high-dose steroid inhaler. The basis of my medication, though, is 450mg, twice a day, of Phyllocontin Continus tablets – I simply couldn’t function if I had to depend on inhalers alone.

Then, in COPD, it’s possible to reach the stage where bronchodilators like Ventolin simply no longer work, because the constriction of the bronchi has become irreversible, but I’m assuming the questioner isn’t in that position – you probably couldn’t be without knowing.

Technique is another reason why it doesn’t work – you must close your lips tightly around the mouthpiece (don’t close your teeth!), and inhale sharply and deeply at the EXACT moment you trigger the inhaler, and draw it deep into your lungs.

With a spacer, you have a little more leeway, but don’t linger or it will settle out onto the inside of the spacer (a tiny amount always does anyway).

It’s vitally important to settle into a routine with your meds – take them by the clock, not just when you remember, or you will suffer for your laxness, and if you have other inhalers, take a dose of Ventolin 20 minutes before the rest, to open up your bronchi and maximise the benefits.

One other thing to consider, and I know this based on over 40 years experience, no matter what NICE would like you to believe, generic Salbutamol inhalers are hopelessly unreliable and mostly complete crap.

If, after all that, Ventolin still doesn’t work, you need a referral to the chest clinic at your local hospital, to find out why. It may be that what ails you simply doesn’t respond to Ventolin (i.e., you don’t have asthma* or, perhaps, COPD), or you may need more aggressive treatment with – as with me – Ventolin playing more of a supporting role, bolstered by other inhalers if necessary.

*Many years ago, my 5-year-old nephew developed a bit of a wheeze. It could have been almost anything, or even nothing, but his doctor prescribed Ventolin and the same high-dose steroid inhaler I use – based on absolutely no evidence that he needed them at all. I advised his mother to lock them away and just wait and see what happened – it was just a wheeze, he wasn’t gasping for breath, after all. What did happen was that in a few days the wheeze went away, and never returned. What damage such a high dose of inhaled steroids would have done to a small child who didn’t need them I shudder to think (steroids are dangerous – period – even when they’re essential).