Ventolin or Advair. Which comes first?

[mlimoges]

Alright, let me start with some background. I've got a homecare client on Advair BID and was just prescribed Ventolin BID to supplement. She is not asthmatic but does have a Hx of pneumonias.

We have a debate going between our nursing team as to which inhaler should be given first. Two of us were taught one way and the other two the opposite. Just looking for some clarification and insight from all of you.

Team 1) Advair first, then Ventolin - this side is arguing that since Advair is long-acting it should be given first and that Ventolin is a "rescue inhaler" and shouldn't technically have been prescribed at all

Team 2) Ventolin first, then Advair - This side argues that while Ventolin is short-acting its the bronchodilating properties that are more important. Giving the Ventolin first allows the brochioles to dialate (obviously) which in turn allows the Advair deeper into the lungs and making it more effective.

[klone, MSN, RN]

Definitely team 2. We're a family of asthmatics here, and we always do the bronchodilator first, wait a minute or two , then give the steroid after.

[caliotter3]

I was taught (and read on product information sheets) bronchodilator first, then corticosteroid.

[mlimoges]

Thank you for your input! I'm with you, to me that just makes sense. Why open the bronchioles AFTER the other medications, seems like kind of a moot point.

Now the only thing i dont understand is why Ventolin is still considered a rescue inhaler if used outside of the asthma spectrum. Yes, is short-acting but when used in the regular capacity that it has been prescribed it just doesnt seem appropriate to call it as such. Am i wrong here? Missing or forgetting something maybe?

[caliotter3]

What I have always found interesting is how many home health nurses I have met who have no idea what one is talking about when one says that the bronchodilator is given first or that you wait about five minutes in between the two meds.

[mlimoges]

i know what you mean, its so frustrating to see nurses that dont know their stuff and have no desire to enhance their learning! I understand people forget pieces of information or weren't taught the same but when nurses dont know basic stuff i worry for the clients

[caliotter3]

They cop an attitude if you politely try to clue them in. What if the client were to ask? After all, I discuss this stuff with the client when I do my teaching. When it comes to these two types of resp meds, I always emphasize this teaching point. Some nurses don't care who knows how lacking in knowledge they are, or how they are too lazy to find out the basics.

[vanilla bean]

Team 1 is incorrect and team 2 is correct - Ventolin (albuterol) first. Ventolin is considered a rescue inhaler for its rapid effect in treatment of bronchospasm. But Team 1 needs to remember that Ventolin is also often used as a maintenance inhaler to prevent bronchospasm.

Please loan Team 1 your drug reference

[mlimoges]

Please loan Team 1 your drug reference

Love the snark haha. I grabbed the literature from the Ventolin box and highlighted the "administer short-acting inhaler before inhaled corticosteroids" and paper-clipped it to the MAR. They can argue with me and the other nurse until their faces are blue but they cant exactly argue against the pharmaceutical company, now can they (Thanks caliotter3 for the idea, i hadn't thought of the medication literature!)

[Here.I.Stand, BSN, RN]

You and Team 2 are correct. The problem w/ this--

Team 1) Advair first, then Ventolin - this side is arguing that since Advair is long-acting it should be given first and that Ventolin is a "rescue inhaler" and shouldn't technically have been prescribed at all

is that while it is used as a "rescue inhaler," it WAS prescribed BID. I don't think that someone who has so much trouble w/ basic pharmacology is qualified to determine whether it should have been prescribed or not. Since both are scheduled BID, yes you give the bronchodilator first for the reasons that you and Team 2 state.

[KelRN215, BSN, RN]

I'm with everyone else. Bronchodilator first to open the airway.

[CamillusRN, BSN]

Agreed - Team 2. Gotta get the bronchioles dilated to give the steroid more surface area to act on.