I have been known to use it earlier. I’m a retired RN what choice do I have. If I’m near my nebulizer I use it instead. But if I’m out I use it early. My pulmonologist told me to use it before I got sob if I was getting ready to exert myself. If your sob you have breathe no choice

I have allergy’s never knew to wait 4 hrs, if I need it I use it.

Stan, just make sure that your doc knows that you are sob before the 4 hours are up. That is significant, she may need to make some changes to your meds or even prescribe a nebulizer, which helps me and lasts longer. In the meantime, sit down and stop your activity when the sob hits until your breathing has improved.

Michael, he told me as did the pharmasist, to use it only as needed but at a max of 2 puffs every 4 hours and no more than 4 times a day to keep side effects down like shaking.

My dr never mentioned using a nebulizer only the salbuteral ( puffer) and the once a day dry puff in the morning ( trelogy Elipta )