Does Ventolin benefit sleeping COPD patients?

This post is a special edition to "My Answer to your Rt Queries." This question was asked of me by an anonymous person who did not leave an email for me to resond to. However I think it is a common enough question that I am going to answer it in a public post.

QUESTION:

Hi-I found your site while cruising around the Internet looking for stuff about COPD.. Anyways your post here got me wondering --- I am caring for mom who was released from hospital last week under Hospice care (we are new to hospice). She has end stage COPD and she is soooo weak, barely eats or drinks now. I started giving her her nebulized Txs a couple days ago even though she is asleep all the time (I was waiting for her to be alert and awake and she still is not, so I felt bad and gave her Txs anyways. -Then when I read where you said something to the effect the pt wanted a neb tx even though she wasn't out of breath.. My mom hasn't been out of breath - do you think I should stop doing the neb at this point.. She was previously doing levalbuterol 4x a day.. Just wondering - any thoughts? - thanks! PS- hospice just always answers - "whatever she wants" - well I don't know what she wants because she doesn't wake up!

ANSWER:

Great question. One thing to know about Levalbuterol (Xoponex) and Albuterol (Ventolin, Proventil) is that most doctors agree with me that you cannot overdose on these meds. They are very safe bronchodilators that can very quickly provide relief for COPD and Asthma patients. I would imagine your mother took this medicine every four hours when she was awake because they provided some relief for her, and comfort. Of course now you don't know if your mother is short of breath or not, but it certainly cannot hurt her by continuing to give these treatments, and they may be of benefit. Of course I'm not a doctor, but I would say if the treatments benefited her while she was awake they will continue to benefit her now while she is sleeping, so it cannot hurt to continue them.

Just to make things interesting, I have always believed if a patient is sleeping they are obviously comfortable. I have had some families in this same situation decide to stop the breathing
treatments to no disadvantage to the patient.

So, based on all that I've written here, you can see that you can go either way, and I think that is why Hospice would say, "Whatever she wants." I actually think they are justified in saying that. They also could have said, "Whatever you think she needs for her comfort."

Personally, I'm not there to see what your mother is like, and I don't know how bad her COPD was before her current situation, so it's difficult for me to provide better advice for you. It is never easy making these kinds of decisions. However, I think your mother would be proud of you that you are doing this for her and thinking of her in this way. Whatever you decide is the right thing.