Mother with COPD complains about cost of Advair, Spiriva & Dulera but refuses to use nebulizer for full treatment time. Advice?

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OzarkOlly Asked June 2015

Mother with COPD complains about cost of Advair, Spiriva & Dulera but refuses to use nebulizer for full treatment time. Advice?

My mother has moderate dementia & COPD. Until recently, she remained stable on a Ventolin inhaler administered with a spacer so that timing wasn't a big issue. Unfortunately, despite 4 time per day usage, that no longer works for her & she wheezed like some old steam engine. The doctor has tried Advair, Dulera & Spiriva, all of which have worked well but my mother adamantly refuses to allow refill of either script because of the monthly price... $300 range for the Advair or Spiriva & $1000 (!!) for the Dulera. I convinced her doc to prescribe a nebulized Albuterol solution thinking the longer administration time would open her up better, get the medicine deeper into her lungs & keep the shortness of breath at bay longer than just a pocket inhaler. I had explained the nebulizer to her & she agreed that she would do it & she was very pleased with the $4/mo pricing at Walmart. Now, of course, that I have everything arranged & purchased the nebulizer machine, she refuses to use the nebulizer for more than a minute or two so she's not even coming close to getting a full treatment. It's just a matter of time before the inadequate treatments catch up with her & she'll become significantly short of breath but no amount of talking, explaining, begging or even threatening will get her to complete a full treatment OR take even a partial one more than twice a day. Of course, when she becomes short of breath, that's all I hear about..."I feel so bad."..."I'm so short of breath"..."I don't understand why I'm so short of breath all of the sudden", etc. When I try to explain why, she becomes angry & denies everything I tell her as being untrue. The longer I try to convince her otherwise the angrier, NASTIER & more adamant she becomes. Any ideas on how I can get her to comply with the nebulizer?

Lung Disease

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score 0 · Answer 1

This gets tricky - what are her rights and what is she simply incapable of doing? It seems to me that she may be rebelling against being told what to do. Is there a way to back off for a little while?

When she get's short of breath, you can say nicely, just let me know if you'd like any help setting up your nebulizer. The suggestion of using a mask is a good one if this is possible for her. You could do some digging there. But unless she is cognitively impaired to the point that she needs complete intervention, you may find that she will respond better to a more relaxed approach, leaving the responsibility of feeling better in her hands - with your standing offer to help. If this is too dangerous for her situation, then ask the doctor for some suggestions for people like her. Please keep us updated.
Carol

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score 2 · Answer 2

Does she have a mouthpiece or a mask? For the lazy, the mask may be a better choice.. set her in frount of the TV and let it run. You really dont need a 20 minute treatment, in the hospital we often just run it for 10 minutes of so, but our flows are higher. The mouthpiece is much more effective, but take what you can get... Good luck

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score 2 · Answer 3

Maybe cream up her hands and legs while she is doing the treatment. When my kids were little I would wait until they feel asleep to give them their last treatment of the day.

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score 2 · Answer 4

My husband has the same two chronic and fatal conditions. Stop trying to convince her as you are only going to make yourself ill. Remembering to take breaths, inhale and hold it (with medication) is a big chore for people with dementia and COPD. You can only do your best, and either illness will be fatal or she will develop fatal pneumonia. Been there, done that and I pray.

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score 2 · Answer 5

Another thought re: those with dementia not wanting to use the nebulizer. Dementia can cause a great deal of anxiety over noise and chaos in the mind. If your parent happens to be hard of hearing, don't do the treatments with hearing aids in. My Mom pulls her aids out and lets them hang over her ears while doing the treatment because she cannot stand the noise of the machine . That seems to make a big difference for her. If she turns that machine on with her hearing aids in, she about jumps out of her skin and is immediately set off into a rant of bad words, cussing and complaining about how the noise upsets her. So with or without hearing problems, it may be the noise that creates the resistance to the machine.

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score 1 · Answer 6

you are going to have to take charge my mother had copd for years and was on 3 different inhaler and only a nebuliser when she had chest infection as dr said makes them laz about taking med properly. she did nit have dementia. howevery I now look after mother I law who has vascular dementia and cannot even rember ho to wipe her self correctly or flush loo so don't think its you mothers falt. any medication my mil takes is given by us as correct time.Mil has lived with us for 2.5 yrs

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score 1 · Answer 7

A mental health specialist would know strategies to play around this. It is challenging where to draw a line between respecting her wishes as an individual and protecting her from self-neglect (the confusion caused by the dementia make individuals with the condition to have short-memory loss or to have their own 'logic', so it is the challenging part for us to go beyond and play the detectives to unveil their logic. It doesn't help -and it won't work- if you try to bring her to reality). I'm afraid if this continues, health care authorities could take those decisions for her, even when she refuses. Has she appointed a PoA or and advocate that speaks for her well-being before a stranger is appointed? I'll leave it with you.

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score 1 · Answer 8

Don't know if a Pulsox meter might help. When you put it on her finger, she might be able to see and understand the need to take her medications.

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score 0 · Answer 9

My MIL doesn't do the treatments unless we say something to her.I keep explaining that she should do them 4 times a day but she thinks she doesn't need them. I keep telling her before she gets up to walk a bit that it would help to do this but still she fights it because its too loud and too long. I feel your pain...

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score 0 · Answer 10

I didn't know we could have commercials on this site!

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Mother with COPD complains about cost of Advair, Spiriva & Dulera but refuses to use nebulizer for full treatment time. Advice?

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